SOURCE_DOCUMENTS/journal_005_1.txt

Volume 5, Number 1 Spring/Summer 1982 
CONTENTS 
The Question of Death in Logotherapy George Kovacs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 
Logogeriatrics Uwe Boschemeyer ........................................... 9 
An Example of lmprovision Kazimierz Popielski ......................................... 16 
The "Birthmarks" of Paradoxical Intention Elisabeth Lukas ............................................ 20 
Some Practical Hints About Paradoxical Intention Joseph Fabry .............................................. 25 
The Belfast Test: A New Psychometric Approach to Logotherapy Bruno Giorgi, Jr. .......................................... 31 
Case Studies with Juvenile Delinquents Louis S. Barber ............................................ 38 
Meaning in Family Therapy James E. Lantz ............................................ 44 
Counseling the Aged Robert C. Leslie ............................................ 47 
Logotherapy in Self-Application: Report from U-One-South-Nine Frank E. Wood ............................................ 53 
A Journey into Meaning Jerry L. Long .............................................. 57 

Book Review ................................................... 59 
Logo-Bulletins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 
Bibliography (Addenda) ......................................... 61 
lnttrnat1onal l·l11urn for LogiHhrrapy \'ol. 5, '\Jo. 2, I·:tll, \\ inter 1982 
LOGOTHERAPY-PRESCRIPTION FOR SURVIVAL* "From the Bitter Came Forth the Sweet" 
Mignon Eisenberg, Ph. D. 
Logotherapy is self-help through the discovery and recovery of the personal meanings of one's life. It is a positive, optimistic, and humanizing approach to the understanding of man. It is more than that: it is a way of life. 
Its great fascination and promise to become the dominant preventive and curative psychotherapy of the twenty-first century lies in its validation process through the purgatory of the Nazi death camps of World War II. 
Tested and proved viable under the most abject conditions of man's inhumanity to man, logotherapy rose like a phoenix from the ashes of total destruction, and became a living statement and testimonial to man's indomitable dignity and to the defiant power and the inalienable freedom of the human spirit. Frankl, the survivor, devised a prescription for survival in an increasingly complex and confusing world. To fill the prescription, you don't have to go to the pharmacy. The miraculous medicine, an ample supply of it, dwells right inside of every person, patiently waiting to be detected, extracted, and put to use. 
Logotherapy restores health and hope by making people aware of the formidable power inherent in them, to stop feeling victimized, and take over control of their lives. This is done through a restructuring and reformulating of some of our most conventional, yet irrational, beliefs. Here are twelve examples: 
1. 
We deserve receiving an answer to our questions about the meaning of life. WRONG. It is not up to us to ask what the meaning of life is. Life sets tasks before each person. In meeting them, we define the meaning of our life; by our actions we answer the questions that life puts to us. 

2. 
Freedom is something that can be bestowed upon or taken from us. WRONG. Freedom is not negotiable; it i& an internal state of mind. To be truly free means to resist causality and temptation, to be true to 


*This was adopted as the theme for the 3rd World Congress of Logotherapy to he held in June, 1983. 
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one's values and virtues, to take a stand, not to do what one wants 
but to want what one has to do. Our freedom to decide makes us 
ultimately self-determining. 
3. 
Man has no control over his body and mind. WRONG. Man does have a body and psyche, which can become ill. Yet man is essentially a spiritual creature, different and distinct from all other living organisms. Man's spirit can never become sick, just blocked. Once made conscious (often through encounter with a logotherapist), it can become the source of a great metamorphosis, to overcome the limitations of body, psyche and environment by changing our attitudes, by turning shortcomings into challenges. 

4. 
Sex is the dominant feature of our lives. WRONG. Sex is justified, even sanctified, as soon as, but only as long as, it is a vehicle of love. Sex without love is nothing but masturbation on another person, resulting in lowered self-esteem. Love means experiencing another human being in his or her essence. It brings out the person's greatest potential for growth. It is an instrument of knowledge, making known to us the values that our feelings made accessible. 

5. 
Happiness is our superior goal. WRONG. Man's primary goal is not happiness or pleasure. Man's main motive is to find meaning in life. Happiness and pleasure are only side products of the search for meaning. Once made into a goal, they will elude us. 

6. 
Material success brings happiness. WRONG. Psychiatrists' offices are filled with desperate, successful clients. To make personal fulfillment and actualization attainable, a person must first become or be made aware of a certain deprivation and failure. 

7. 
To cope with present crisis, we must resolve the past. WRONG. It is not essential to dwell on past experiences in order to handle present disturbances caused by past trauma. The past, once examined, can be returned to its unconscious resting place. Logotherapy confronts the person with the future so he can overcome the past. 

8. 
Lack of peace of mind, of homeostasis, of inner equilibrium are symptoms of illness or pathology. NOT NECESSARILY. Mental health is based on a certain tension, the tension between what a person has achieved and what he is destined to achieve, between what man is and what he can become. It is the absence of tension that breeds boredom and depression. 

9. 
To overcome anxiety and obsessions, stop thinking about them. WRONG. Paradoxical intention, one of the major techniques of logotherapy, teaches us to mobilize our sense of humor in order to diffuse anxiety and get rid of obsessions by playing a very conscious 


68 
game of "get that fear" with ourselves, pretending to enjoy what frightens us most. A great coping device, making trifles of tragedies, instead of tragedies of trifles-therapy through laughter. 
10. 
We can solve a dilemma or escape depression by concentrating on it to the exclusion of any other thought or action. WRONG. Here perhaps lies logotherapy's greatest contribution, directing us to our capacity for self-transcendence, using the survival technique of dereflection: forgetting ourselves by reaching out beyond, outside ourselves, for people to love, actions to accomplish, causes to serve. 

11. 
There are situations in life that are hopeless. WRONG. There is no situation in life devoid of options, choices, alternatives. If we can change a situation, we must. But, if we are in a trap, a blind alley, a situation beyond our control, we must accept it. Rather than trying to change the unchangeable, we still have the alternative to change ourselves, our attitude. 

12. 
Guilt is an unacceptable feeling. WRONG. Guilt is a uniquely human trait, a laudable sensation. Guilt is one of the components of the tragic triad which is an unavoidable part of the human condition. The other two are suffering and death. Guilt can become the catalyst for conscious moral rebirth, for the revamping of one's character, by seizing the "second chance" given to each of us. 


13 Responsibility is a behavior pattern that can be dictated or terminated by outer authority. WRONG. Response-ability is one of the prime activist resources slumbering in the spiritual treasure chest of each one of us. No one can deprive us of this uniquely human and personal potential of defining and redefining ourselves by our actions. 
14. Death renders life meaningless. WRONG. It is the very knowledge and acceptance of our mortality that makes life meaningful. Constantly confronted with our finiteness, we sense the urgency and importance of making every day, every moment count. 
I recently returned from Israel after a five-month stay as guest lecturer at two universities, teaching logotherapy to graduate students of psychology and to social workers. Many of my students were children of survivors of the holocaust or themselves survivors, but certainly all were survivors in the sense that they had come in contact with death physically or psychologically, survivors of at least imagined or anticipated holocausts.We must try to visualize the situation in Israel, where war, terror, alertness to the danger of imminent threat to one's life or the lives of those closest has been an everyday reality for the last thirty-four years, since the establishment of the 
69 
State. Most of my students had completed their three-year compulsory military service and had not known a day of absolute peace since the day of their birth. 
During my extensive and very intensive visit, I had occasion to find living proof of Frankl's statement, "Suffering and trouble belong to life as much as fate and death. None of these can be subtracted from life without destroying its meaning. To subtract trouble, death, fate, and suffering from life would mean stripping life of its form and shape. Only under the hammer blows of fate, in the white heat of suffering, does life gain shape and form." 
In one of his philosophical feuilletons, Theodor Herzl, visionary of the Jewish State, wrote in 1896, "Despair is a precious material out of which one can create great values: courage, moderation, justice, and selfsacrifice ...all great persons in the history of mankind once stood at the last frontier and returned, their despair bearing fruit. All inventors, prophets, heroes, prominent statesmen, artists, writers, and philosophers ... there is no loftier philosophy than the one that comes to us after we stood face to face with death ... '' (The Inkeeper of Anilin) . 
The social work and psychology students in the troubled land of Zion seem to have made their choice. In times of uncertainty over territorial boundaries, they already opted for secure moral boundaries in the geography of their souls, where the horizon is limitless. Survivors of violence and wars, with more of the same in store, they emerged stronger due to the sobering awareness of their sense of vulnerability, their feelings of guilt for having survived their comrades who fell in the wars. They overcame the temptation to decide to fall into depression, despair and apathy, or to become cynical and suspicious of all human relationships. No. Quite the contrary. They found universal wisdom and a source of insight and power in their struggle for a re-ordering of their priorities. Having touched death, they emerged with a renewed reverence for life, with a zest for actualizing spiritual values and a resolution to strive for the Ultimate Meaning-a happier future for mankind. 
They seem to be wise and mature beyond their years. Their responses reflect messages similar to the ones expressed by children and orphans who survived the horrors of war across the globe. 
In conclusion, here are some quotations from children and teenagers in war-torn countries of the I 980's: 
"I will take revenge; make the most out of my life." 
"I feel guarded by my father's spirit. In my dreams he told me to 
gain knowledge and thus take revenge on his killers." 
"Revenge is to make a man better than before ... Revenge is 
fighting the bad in oneself." 
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"I want to become an artist so I can give something to someone and allow someone to love me in return ... '' 
"Life consists of difficult moments. In order to earn a happier time you have to suffer hardships ... " 
From the Bitter Came Forth the Sweet. 
MIGNON EISENBERG, Ph.D. is a certified logotherapist in Chicago and Regional Director of the Midwest Region ofthe Institute ofLogotherapy. 
THE INSTITUTE OF LOGOTHERAPY offers Life Memberships of $500 (in gifts or pledges) to persons who wish to help us achieve the following goals: 
Leasing a permanent center in downtown Berkeley for the growing administrative work ofthe Institute to provide space for counseling, training, and Chapter meetings. 
Employing a paid full-time office person. So far all work is done by volunteers. 
Obtaining word-processing equipment to print our own announcements, and do the typesetting for our Forum and for the publications of the recently established Institute of Logotherapy Press. 
Establish yearly scholarships. 
The following persons have become the first Life Members: 
Joseph Fabry Judith Fabry Viktor Frankl Rosemary Henrion Muriel James Stephen Kalmar Vera Lieban Kalmar Ernest Nackord 
In addition the following persons have sent us donations of$ I 00 or more: 
Self-Transcenders ($300-$499):  Dereflecters ($100-$299):  
Christina Lebworth  Edgar Bodenheimer  
Kenneth Woodroofe  William Hanks  
Frank Humberger  
Irmgard Wolf  

71 Edward Demolder 

ARTHUR KOESTLER (1905-1983) 
On March 3, 1983, the Institute of Logotherapy lost a good friend, a member of its Board of Consultants. The World lost one ofthe century's most original thinkers, a conscientious seeker of truth and meaning. 
From his early days in Vienna, where he had known Freud and Adler, he became interested in psychology, politics, and science, and required the 
for improving the human chances for a meaningful life. This almost adolescent urge, as Koestler himself called it, stayed with him until his death. His creative, curious, analytical and courageous mind made him pick up causes and fight for them fervently. It also made him give up causes when he found that falsehood and lies had invaded them and had replaced their original goals and ideals. 
During his later years Koestler's interest turned more and more from political to psychological, philosophical, spiritual themes, natural and supernatural forces. 
The Institute of Logotherapy invited Koestler to address the Third World Congress of Logotherapy in Regensburg. His reply arrived a few days before the news of his death. 
January 31, 1983 
Dear Dr. Fabry, 
I am sorry that I shall not be able to 
attend your Third World Congress in Regensburg in 
June. 
Thank you all the same for asking me 
and please give Viktor Frankl my warmest greetings. 
With best wishes, Yours sincerely, 
A. LA.~~~ 
Arthur Koestler 
We understand now why he stated he could not come. He had already made his final choice, to end his life, his battle against his Parkinson's disease and leukemia. 
-Stephen Kalmar 
72 
international Forum for Logotherapy Vol. 5, No. 2, Fall/Winter 1982 
The Viktor E. Frankl Merit Award 
A Viktor E. Frankl Merit Award was established in 1982 by the Board of Directors of the Institute of Logotherapy. It offered a $500 college scholarship to California high school seniors for the best essay on the subject, "The Role of Logotherapy for Youth in the 1980s." It was to be no more than 1500 words and to contain at least two references from Frankl's Man's Search for Meaning or Fabry's The Pursuit ofMeaning. 
The Institute wished to provide a forum for young people to express some of the unwritten thoughts and feelings, to vent their frustrations, and test their ideas about the world in which they live. We also wanted the young people to become familiar with the ideas of logotherapy which seem to us a prescription not only for the health of the individual, but for the health of the world. 
A mailing list was developed from the handbook of accredited public and 
private high schools in California. Every senior high school received a letter ad
dressed to the principal in which the essay contest was announced. Attached to 
the letter was an application form requesting some pertinent information about 
the participating student. 
Submitted were 92 essays from 43 schools in 36 different cities from as far 
south as San Diego to as far north as Loomis, a small town near Sacra
mento-a span of 600 miles. Only four schools submitted more than four 
papers. The overwhelming majority came from individual students and ap
peared not to be part of any class project. Students in the upper 20 per cent of 
their class, most of them college bound, dominated the entries. The essays 
varied in emotional intensity, intellectual comprehension, and style of presenta
tion. There were typical essays, short stories, personal biographies, and some 
attempts at humor and cynicism. A panel of three judges was selected from 
among the Board members of the Institute: Stephen S. Kalmar, Bianca Z. 
Hirsch, and Julia G. Beard. All entries were submitted to them with all iden
tifications eliminated. 
After careful deliberation the panel selected the essay by Derek L. Dean as 
the prize-winner. Because of the high quality of many other entries the judges 
decided to award 12 additional prizes: annual memberships of the Institute of 
Logotherapy which include a free subscription to the International Forum for 
Logotherapy. 
Mr. Dean's essay and those of six runners-up were to be presented, with a 
scroll, to Dr. Frankl at the Second World Congress of Logotherapy. Because 
he was unable to attend for health reasons, the scroll and the essays were sent to 
Frankl to Vienna. 
The prize-winning essay is printed in this issue of the Forum, and others 
will be printed in subsequent issues. 
Willis C. Finck 
President, Board 
of Directors 
Institute of Logotherapy 
71, 
International Forum for Logotherapy 
Vol. 5, No. 2, Fall/Winter 1982 
THE PURSUIT OF MEANING FOR YOUTH IN THE 1980s 
Derek L. Dean 
SOCIAL STAGNANCY 

Today's society is faced with many difficult problems, few of which are easily soluble. Throughout the social, political, and economic spheres problems exist that are interrelated, but it is difficult to find one common characteristic to describe them. Upon examination of history, however, it becomes evident that a huge conflict has developed within humanity itself. This conflict has its basis in such phenomena as the Renaissance, the Industrial Age, the Enlightenment, the Atomic Age, and the achievements of modern technology. Humanity's ability to deal with itself has not progressed. Society on the world level does not relate better socially or politically today than it did 200, 500, or 1,000 years ago. The human mind has made fantastic scientific and technological advances while it has remained stagnant in the area of human relations. Obviously it is not feasible to slow the progress of technology; the only alternative is for humanity to overcome this "stagnancy" before it destroys itself. 
Before such a challenge can be accepted the nature of the source of the problem must be examined. To understand this problem on a societal level first requires examination on the individual level. As a person today develops from childhood to adolescence to adulthood, he will undergo a renaissance, an industrial period, and an enlightenment. As he becomes more aware of the society around him, he begins to adopt its ideas; he is conditioned. Technologically his mind will develop rapidly; he will learn the scientific method and the dialectic. However, one concept will not be impressed upon him. He will not be taught that he has a meaning in life. A humanist may say to him: "Man's purpose in life is to serve humanity." The person may understand and accept this, but in the back of his mind he will wonder if that is really his meaning in life, and why he didn't feel it before. This is one of the major problems in education today: children are not taught to pursue for themselves their meaning in life, their "will to meaning." The result is that as this person grows older he is aware of his desires, his goals, and his need to fulfill them. He is unaware of the meaning of it all. Too often the will to meaning is ignored and the person tries not to worry about it, but he will rarely succeed. If the person does turn to "selfinterpretation" he will probably only compound the problem, as Viktor Frankl points out in The Unconscious God: "As the boomerang returns to the hunter who has thrown it only when it has missed its target, so man 
7A 
returns to himself, reflects upon himself and becomes overly concerned with self-interpretation only when he has, as it were, missed his mission, having been frustrated in his search for meaning." This frustration of the will to meaning is labeled by Frankl in Man's Search for Meaning as "existential frustration." On the societal level this becomes an existential vacuum. 
To relate existential frustration to the problem of social relations requires further elaboration of the effects of the existential vacuum. Existential frustration on the individual level results in feelings of futility and meaninglessness or in the more serious problems of what Frankl calls "noogenic neuroses," which arise out of spiritual and moral conflicts. On the societal level the existential vacuum causes three major problems which Frankl has identified in The Unconscious God as the "mass neurotic triad:" depression, addiction, and aggression. These problems are more than Freudian defense mechanisms because they are not motivated by external or past or conscious problems; they are the results of spiritual frustration. The extent of depression, addiction, and aggression depends upon the character of the person. Today, spiritual frustration is so widespread that it is affecting the social relations between people, societies, and nations. Aggression and hostility have become a part of the American way of life. Children are conditioned to believe that communism is bad, that other cultures are inferior, and any number of other prejudices. When the result of the existential vacuum becomes a part of a child's conditioning process, a vicious circle is established. In Man's Search for Meaning, Frankl states of man: "More and more he will be governed by what others want him to do, thus increasingly falling prey to conformism." To break this circle requires knowledge of the concepts of logotherapy and the will to meaning. 
To solve the problems of existential frustration and to rectify the stagnancy of human relations, people must find meaning in their lives. One of the fundamental values of logotherapy is that it does not provide a person with meaning, rather it induces him to find it himself. The manner in which a person discovers meaning may appear on the surface to be quite simple when it is actually almost a revolution in thought. Self-actualization is not a viable method because as Frankl points out in The Unconscious God: "The more one forgets oneself... the more human he is." The method that is to be used is rather that of self-transcendence. Frankl sees the spiritual unconscious as an unconscious God. Frankl also believes that an understanding of the "transcendent quality of conscience" is necessary. The person must see his conscience as something based in this unconscious God, something to be served, something transcendent of himself. The conscience is the person's key to meaning because it provides him with the only way to find meaning despite society's conditioning. In Zen and the Art of Motorcycle Maintenance, Robert Pirsig developed the idea of preintellectual awareness that determined quality before the rational, intellectual processes took place. Frankl speaks of a pre-scientific understanding and a pre-logical understanding of being, but he carries the idea further to a pre-moral understanding: conscience. This is why no one 
75 
can tell the person his meaning in life: meanings are unique, wherease morals, traditions, and values are transitory. In The Doctor and the Soul, Frankl propounds the idea that responsibility will help give man meaning. The person must feel responsible toward his meaning, toward that which his conscience dictates. Logotherapy cannot tell the person to what he should be responsible because it would be a question of morality. To break the vicious circle of conditioning that is impairing social relations people must become aware of their responsibleness, their self-transcending conscience, their personal unconscious God. 
In this world where war, suicides, drug addiction, and the other consequences of the existential vacuum are prevalent it will not be an easy task to improve social relations. Students must learn to question the teachings of physics, rhetoric, philosophy, and anything that is taught by someone else. Government officials must learn to trust their conscience, not rely on the dictates of what Freud would call the "pleasure principle." It is equally dangerous for government officials to follow the dictates of what Alfred Adler (Frankl' s teacher) would call the "will to power." In order to unite, people must become aware that they are already united in their humanness. They must see each other as mere cells in the body of humanity. They must acquire feelings of responsibility. This will be accomplished only if they find meaning in their lives. As Albert Einstein said: "The man who regards his life as meaningless is not merely unhappy but hardly fit for life." Meaning can be acquired at any point in life, as evidenced by Ilvan Illych in Tolstoy's The Death of Ivan lllych or Meersault in Camus' The Stranger, but time is running out. If humanity has not overcome its social stagnancy before the end of the century, its technological and scientific achievements will likely destroy it. This, then, is why the pursuit of meaning for youth in the 1980's is so important. 
DEREK L. DEAN was, at the time ofthe contest, a senior at Granada High School, Livermore, California. He is now a freshman at Carleton College, Minnesota, interested in the field ofpolitical science. 
76 
International Forum for Logotherapy 
Vol. 5, No. 2, Fall/Winter 1982 
What Logotherapy Can Learn from High School Students 
Stephen S. Kalmar 

Contrary to the usual questionnaire-type of tests probing into the meaning orientation of people, the Viktor E. Frankl Merit Award contest allowed the participants to speak freely about whatever they personally considered important in their search for meaning. The opinions expressed went far beyond the often generalizing, superficial, stereotyped, biased views heard about the young men and women of today. They contradict the views so widely repeated in the media that present ''the youth'' of today as a mass of selfish, inconsiderate, rebellious, violent, drug-addicted, purposeless people. Many of the essays proved such views false, unfair, and even harmful to a large number of students who seriously are searching for a purposeful solution of the problems confronting them. They feel that such generalizing views are minimizing, or not even seeing the real problems the young people of today have to struggle with, and that such lack of understanding is unnecessarily polarizing the generations. 
UNIQUENESS 
Almost every participant stressed the need and the right to be judged individually. One of the essays stated: 
My grandmother considers my problems (which seem so immense and overpowering to me) as ridiculous when compared to the things she went through in her life. The only ridiculous thing in this case is the comparison. One cannot compare one person's problems with those of another because the person, the time, and the circumstances are so very different. 
The most outstanding issue expressed in these essays was the desire to search for and find personal unique identity, with unique characteristics, values and goals. This longing is indicated, first, by the fact that the most 
77 
often quoted stateqients from the two texts were concerned with the individual's right to a unique meaning; second, that the quotations were truly individual choices-76 of them were not repeated by any other participant; and, third, many of the essays dealt with a specific problem that was important to that specific participant, and hardly mentioned by the others. 
The statement quoted most often, by 20 of the essay writers, came from Frankl's Man's Search for Meaning: 
One should not search for an abstract meaning of life. Everyone has his own specific vocation or mission in life; everyone must carry out a concrete assignment that demands fulfillment. Therein he cannot be replaced, nor can his life be repeated. 
This concept of logotherapy was appreciated by the students-a judgment confirmed by other popular quotations stressing uniqueness: 
The meaning of life differs from man to man, from day to day, and from hour to hour (quoted twelve times). 
Man's search for meaning is a primary force in his drives ... This meaning is unique and specific in that it must and can be fulfilled by him alone; only then does it achieve significance which will satisfy his own will to meaning (five times). 
Life does not mean something vague, but something very real and concrete, just as life's tasks are also very real and concrete. They form men's destiny, which is different and unique for each individual (four times). 
Each man is questioned by life; and he can only answer to life by answering for his own life (four times). 
Among the personal concerns mentioned by the essayists were: "Achieving authenticity" -"The vulnerability of youth"-"Achieving significance"-"Satisfy one's curiosity"-"Achieve harmony with nature"-"Acquire creative thinking" -"Eternality" -"To be able to laugh about problems"-"To love, and being loved"-"To make decisions"-"Satisfaction from actions" -"Find directions" -"To be committed"-"Responsiveness." This is far from a complete list, but read together it sounds almost like a logotherapist's prescription for the pursuit of meaning. Yet, each essayist chose only one of those concepts as his or her main concern in life. 
Although many students wrote about their own main personal concerns, they also had something to say about general problems confronting the young people of the 1980s, such as: Turbulent insecure economics-threatening depression-growing unemployment, especially for youths-breaking down of tradition and need to find new values-growing number of divorces of parents-diminished family 
751. 
support· and · fewer family activities-greater competition and resulting stress and anxiety-need for peer acceptance-escape from personal difficulties into use of drugs, alcohol, rowdiness and violence, easy sex and "punk" behavior. 
The two main problems of the greatest personal concern for many participants were the fear of a nuclear war as a consequence of the growing arms race between the superpowers, and the danger to the world and nature from the growing industrial abuse and exhaustion of natural resources. Many of the essayists vowed to make the preservation of peace and the preservation of nature their meaning-in-life in the 1980s. One wrote: 
The meaning we strive to attain is a world in which culture and ideas, not threats, are exchanged by countries. It is a world in which we work together in harmony with the process of the earth. There is a tendency to label this ideal a Utopia folly; it is in fact our only choice. 
Another participant suspected anger in today's youth to be the source of energy that drives them to absurd acts and violence. But anger, he realized, can also provide energy for constructive acts instead of destructive actions. He reported that he himself, angry about the cruel treatment of Jews in Soviet Russia and the almost complete impossibility of Jews to learn Yiddish or Hebrew or to find prayer books and to practice their religion, took it upon himself to collect a sizeable amount of Hebrew books, and he never felt such joy and meaning in life as on the day when he mailed the books to Russia. 
Cooperation rather than competition was often mentioned as a desirable value. Many participants stated that the task of the youth today was to change the "me" society of the 1970s into the "we" society of the 1980s. 
EDUCATION 
Many essays maintained that the question of meaning should be asked not in a general way but should be specific. One essayist said: "How can I know for what to search if I don't know what I want?" The students were impressed by what logotherapy was saying in specific terms about meaning, and the individual's need to find meaning and to accept responsibility for his choices. At the same time many blamed parents, teachers, and the whole educational system for the young people's difficulty in making purposeful decisions and accepting responsibility for their actions and attitudes. One essay, among many, made this point by stating: 
The school system is not capable of helping the youth to form goals and find meaning in what he is doing. The student is instantly transformed from a human being to a mere number the moment he steps onto the school grounds. He is forced to learn facts which for the most part are 
79 
irrelevant to his life and will be quickly forgotten. Classrooms are overcrowded and the teachers lack motivation ... There is little room for creativity, and the creative expression is lessened every time the class size increases. When a student seeks a meaning behind his education he is faced with nothing but red tape and robot-like administrators. The student, discouraged by the school system, turns to the parent for guidance. The parent arrives at home at 5 PM from his unrewarding job to find his child waiting with the question, "What is the meaning in life?" The parent is too proud to admit to his child that he himself has pondered this question and could find no answer. He proceeds to tell the child that the most important thing in life is 'to get a good education.' This answer does not help the child who knows that his education at school today does not train him for a meaningful life. 
One of the most important lessons which logotherapists can learn from this contest-a constructive lesson which should lead to logotherapeutic programs to remedy a bad situation-is what many essay-writers described as faults in today's education. The best way to secure a more meaningful pursuit of life in the 1980s is to provide the young with a better education for such a goal-now. Many contestants clearly make their points. Here are three samples: 
"Instead of intense training for students in obsolete careers, a program which includes reasoning and creative thinking should be mandatory. Since the students learn their attitudes from teachers, the college personnel must exemplify the ideals of a flexible and innovative thinker. Only when these changes have been made can the future of the world be assured." 
"The society today needs to strengthen creativity, originality, and understanding amongst one another before the youth will begin to search for his own meaning as an individual ... having one's own dreams, fantasies, goals, and achievements is a goldmine ... 
I know what I want to do in life and I need a college education to realize this goal. With a college education I can obtain my multiple-subject teaching credential ... No other career gives greater meaning or joy to my life. As a teacher my role will be much like that of a logotherapist's. I will be responsible for revealing a whole new, different world to my students, so that they may have a clearer and broader view of the meaning and values which exist in the world. I will have an immense influence on their personalities and views which will stay with them for the rest of their lives. My part in the meaning for youth will continue for many years past 1982. 
The time has come for logotherapists to listen to these young essayists and no longer deal with education as a stepchild but as one of their main concerns. Until now logotherapy has geared its work mainly to the task of helping adults get out of the mess they have gotten into. What is required is to help prevent young people from getting into such a mess in the first place. This approach would help the youth generation, the adults, and society at the same time. 
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SUFFERING, SUICIDE, DEATH 
It was encouraging to see that in spite of individual and general complaints many essayists confirmed that they have found meaning and purpose for their life; meaning for their future from their own past experiences; and meaning from sufferings and bereavements. Some had contemplated suicide when life and suffering had seemed senseless but they had come out of such despair and reached a deeper meaning of life through it. They widely quoted Frankl's statement that nobody has the right "to throw away one's life." Many other of Frankl's statements about the meaning of pain and suffering were also quoted. The essayists were impressed by the fact that those statements were not of a theoretical nature only, but were based on his own experiences in the concentration camps. Here are some quotations from the essays: 
One of the hardest times l can recall was losing my faith in life after the death of my sister. I found it hard to find any meaning in something that seemed so senseless. I had always expected a life of luxury, without suffering. When times grew tough, I went into a severe depression and tried to run away from misery. The contemplation of suicide was always on my mind. Suddenly I realized that my life was not just my own. I did not have the right to hurt myself without thinking of others. If I felt that my own life wasn't worth living I could live for someone else: my family, my friends. This kept me going and brought me out of my depression." 
"Death brings the end to aimless wandering, day in day out. However, this solution is not acceptable to me. It is like working out a math problem halfway, then guessing at the answer." 
"Two years ago, my best friend's dog, Tojo, was killed by a car ... At first I cried for my friend ...My friend believed he was responsible for Tojo's death, and I knew the pain he felt. I then cried for the little dog ... A week later, I began to cry for no apparent reason. It took me a while, and then I realized the significance of Tojo's death. I might have been the one who was killed, not the dog. I had been on earth sixteen years and had accomplished nothing. My life was empty and without meaning. I began to notice things I had once overlooked. I then made a vow to myself. 1would spend my adult life benefitting mankind. I hope to be a part of the health profession. 
One essayist spoke about the experience he had when his grandmother had to be operated on for cancer in her jawbones. In the hospital a good part of her face had to be removed and he was most reluctant to accompany his father for a visit to the hospital. 
Never in my life had I felt such fear ... Walking down that corridor to her room was so painful ...The physical transformations were horrifying. I forced back the tears that stung my eyes, and I reached out to grasp her hand ... She could not speak through the tubes and 
81 
bandages: the entire left side of her jawbone had been removed. 'You are alive' I whispered softly to her. A tear slid down on the side of her sunken face. She squeezed my hand. A deep sense of meaning overcame me ...The fear was still in me but it had gradually lessened. It was replaced by the reassurance of my purpose ... l went to the hospital each day after school ...I felt my meaning was obvious. I was satisfied with myself. 
RELIGION 
A large number of essayists expressed their unshakable belief in God who had prepared a specific and individual meaning for each of them. Many of Frankl's statements were to them confirmations of their own faith. Especially quoted were statements about "ultimate meaning" versus "meaning of the moment." They had no difficulty in accepting both of these concepts. Some essays contained beautifully written parable's and metaphors, such as, life being a difficult mountain climb with many dangers of getting lost, yet with the chance of reaching the summit through faith and perseverance. 
Here are some passages quoted from the texts: 
Man is searching. But he can never decide if he is looking for a God he has invented, for a God he has discovered, for a God he cannot find, or for himself. 
The majority (of patients) consider themselves accountable before God; they represent those who do not interpret their own life merely in terms of a task assigned to them but also in terms of the task-master who assigned it to them. 
[Man's search is for] a world beyond man's world; a world in which the question of ultimate meaning of human suffering would find an answer. 
Almost all essayists struggled with the concept of "responsibility." In assessing their difficulties in reaching responsible decisions about their everyday problems and about actions which would determine their future, they frequently blamed their schools, parents, or society. Yet they expressed their understanding that it was their own, their inescapable task to solve their problems themselves and to accept the responsibility for their final decisions and attitudes. A strong religious faith seemed to help them accept responsibility for their decisions. Many stated that Fabry's and Frankl's books made them more aware of their need to make more purposeful decisions and to accept responsibility for the failure or success of their actions and attitudes. 
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Here are some of the statements quoted from the books: 
Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which are constantly set for one. (quoted nine times). 
Logotherapy sees in responsibleness the very essence of human existence. 
Logotherapy tries to make the patient fully aware of his own responsibleness . 
. . . life imposes obligations, and pleasure and happiness come from responding to the tasks of life. 
LOVE 
Many essayists stated that love provided meaning to life, and helped them develop courage, self-esteem, and hope. 
Love goes very far beyond the physical person of the beloved. It finds its deepest meaning in his spiritual being (quoted five times). 
I grasped the meaning of the greatest secret that human poetry and human thought and belief have to impart: The salvation of man is through love and in love (four times). 
Love helps the beloved to become as the lover sees him. 
PAST AND FUTURE 
A number of the participants were concerned with how much their past was causing their present problems and how hard it was to free themselves from the burdens of the past. They recognized that accepting the demands of the present and planning for the future was a consequence of becoming an adult. Several essayists stated that a great problem for the young people was to accept the fact that their childhood was dead. They had tried for too long to hang on to seeing themselves as "children." To quote from one 
essay: 
It may be that I find security in the past, for it has already occurred and is something pleasant to look back on. Or, my recurring thoughts of the past may be caused by my apprehension toward an unknown future. The happy memories are refreshing. Yet, many times while occupied with retrospective thoughts I discover that I have let the present go by untouched. 
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While analyzing the importance of the past, many students saw their future life benefit from an easy childhood. They understood that nostalgia, pessimism, or despair are unsuitable tools to prepare for a better future. Only a few participants showed a pessimistic outlook. Most of them agreed with the affirmative philosophy of logotherapy. Frankl's statements about every person's ability to create his or her own future found much appreciation and were mentioned in the quotations. 
A good number of essayists took a positive stand toward a future ruled by technology and the computer, and were looking forward to becoming part of it and to helping humankind benefit from it. 
This small sample indicates the variety, depth, and originality of the essays in this contest. It seems to show that the need to find meaning and purpose in life is as great, or perhaps greater, than when Viktor Frankl was 17 years old and started to speak about "meaning in life" at the psychoanalytical meetings in Vienna. It may well be that in the Austria of the 1920s considerably fewer young people agreed with his theories than do persons of the same age in the United States of the 1980s. 
STEPHENS. KALMAR is a member of the Board of Directors of the Institute of Logotherapy and served on the panel ofjudges for the contest. 
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International Forum for Logotherapy Vu!. 5. No. 2, fall/Winter 1982 
Logotherapy: A Grief Counseling Process 
Mary Ann Maniacek 

Logotherapy can be used as a grief counseling process because its principles deal with the most profound issues of life. Grief is one of these issues. The search for meaning is the primary issue to be dealt with for the continuance of living for the survivor. Defeat can be turned into victory if this process is understood and made applicable. 
Logotherapy provides direction for the bereaved while the normal grief process is taking place. Once we learn a way to cope with a loss, we can use this experience all of our life as losses take place. Change is inevitable and, as life continues, we experience numerous losses. Logophilosophy teaches a way to understand these numerous losses in terms of searching for meaning in every situation in our life. Not only searching for meaning, but also using the meaning that we find for continued growth. It is the task of the grief counselor to find a viable method to direct grieving persons toward finding or restoring meaning in their lives or motivation to continue. 
Logotherapy offers an existential process that can "free the despairing individual to generate the meanings of hope. " 2 If we can move into the grief, confront the grief, experience the trueness of it, we may become freed of anxiety and depression. When a significant loss occurs, the meaning of life, meaning in purpose, or desire to continue is threatened. Connection is severed. Logotherapy, by focusing on meaning and the search for meaning, connects the individual to a larger universal world. 
"Man lives in three dimensions: the somatic, the mental, and the spiritual." 1 Integration of these three dimensions is a vital outcome of the grief process. Many therapists ignore the spiritual aspect of the human being, which in turn means ignoring the will to meaning. Logotherapy directs changes in us, making us aware of our innate humanness which contains resources that allow us to transcend the mere appearance of a situation and reach beyond. Frankl refers to our "spiritual core" as a "specifically human dimension." It is through this dimension that we can spontaneously express our creativity. This allows us to search for meaning in the moment, so we can become richer in purpose as a part of a universal meaning. To this human dimension therapists must appeal. The will to meaning is specific and personal, created by each person individually. 
In theory, counseling should provide a well-defined and structured process indicating stages and the tasks to be accomplished. The organization of the stages and tasks can be used as a guide for the counselor to provide direction as the encounter moves to successful termination. The counselor can also evaluate the progress as the stages are completed. In practice, however, the steps overlap and blend with one another as well as move back and forth: the structured process can be flexible. Grief will also intensify existing personality patterns. Past losses need to be explored by the counselor to determine if there is any carryover from unresolved issues. 
FIVE STAGES OF COUNSELING 
Each individual will react differently to any counseling situation. Counselors will have to be creative, flexible, and intentional enough to recognize this factor. They will also have to keep in mind the cultural background as well as the religious beliefs of the client. The following is a hypothetical presentation of a logotherapy grief counseling process. Stage I, Contacting: 
Tasks: Establishing a relationship of mutuality between counselor and client. A climate of trust enabling unconditional acceptance is necessary for the clients to express their feelings. The counselor uses the counseling skills of effective listening, empathy, paraphrasing, and appropriate sharing. Stage II, Assessing the Situation: 
Tasks: I. Identification of the lost person and his or her symbolic meaning to the client. 
2. 
Observation of defense mechanisms. 

3. 
Observation of coping devices. 


a. 
Counselor allows the client to complete the relating of the event and, if necessary, to repeat it as often as the client needs to do this. 

b. 
Counselor uses the counseling skills of paraphrasing, clarifying, and appropriate interpreting. 


(I) 
The counselor will first paraphrase and secondly clarify to have an idea where the client is in the grief process. 

(2) 
From this information the counselor will be able to determine direction and structure of the counseling process. (Note: Many models of the normal stages of the grief process have been presented by different researchers. The stages are usually placed in sequence in order to act as a guide. Everyone does not necessarily experience the stages in a particular order. As an overall assumption the stages will be experienced and, if denial can be brought to realization and allowed expression, resolution can take place. Grief is not totally resolvable. 


Nevertheless, if the counseling helps the bereaved understand that what they are feeling, thinking, and saying is normal, pain can be alleviated and normal functioning can be the outcome.) 
In the first two stages the groundwork for effective intervention is laid by the counselor. Stage III, Intervention: 
Tasks: The counselor will be: looking at what is most feared and confronting it; asking for a description of what the feared aspect looks like and feels like. (The clients may be afraid of their own dying, death, or nonbeing.) 
a. 
The counselor uses the counseling skills of paraphrasing, questioning, feedback, and confrontation. 

b. 
The counselor uses techniques such as visualization exercises appropriate to the client's experience. 

c. 
Discussion, probing, interpretation, and confrontation take place after the visualization exercise is completed. At this point the counselor directs the discussion toward understanding the concept of the existential vacuum, which can be defined as a "void" or "hole." It is common for grieving individuals to express a feeling of "emptiness" or "nothingness" at a time of loss. 

d. 
The counselor presents questions and feedback to the client in a manner that will provide alternatives or generate new ideas for thought to enable the client to put the event in a better perspective. Stage IV, Reconstruction: 


Tasks: The counselor uses interpretation as well as directives to help the clients find constructive ways to fill the empty place described by them. 
a. The counselor is seen in the role of a teacher or educator. 
(1) 
The counselor establishes that everyone experiences a natural grief process after any significant loss. The counselor identifies each step of that process as seems appropriate in the specific case. 

(2) 
The counselor teaches logotherapy's concept of the human being based on three pillars, the freedom of will, the will to meaning, and the meaning of life, including the possibility of meaning in unavoidable suffering. 

b. 
The counselor suggests that now that the clients have experienced, in fantasy form, facing what they most feared, and survived it, the search for renewed meaning can continue. 

(1) 
The counselor structures the questions in the following manner: What gifts (value) did you receive from the identified lost person? What was his or her value to you? What is the meaning in the gifts? What symbols can you identify in connection with the lost person that can make life meaningful when you are presented with them? 

c. 
The counselor will also teach in a discussion, question and answer format, the tenets of substitution in relationship with loss. Substitution does not mean replacement of what has been lost, but a continuing search 


for meaning in the moment or for purpose through meaningful relationships, interests, and dedications. What is mentioned could be viewed as substitutes for what has been lost, but replacement in the fullest sense of the word is not feasible. To try to replace what has been lost would be fruitless and frustrating. (Meaningful memories of the past can provide motivation to search for renewed meaning in the present as well as anticipated meaning for the future.) 
d. Another visualization exercise is to be initiated at this time: 
(1) 
to ensure integration or internalization of the newly acquired knowledge; 

(2) 
to reinforce how the client can constructively fill the "vacuum," "hole," or "void" with meaning. 

(a) 
Look for pictures of the lost person. 

(b) 
Write down past memories of what you did together. 


The following is an excerpt taken from a letter written by a woman to her father after his death. This is an example of the "symbolic meaning of the lost person. " 
... The next ten days were the days of waiting, hoping, denying yet knowing. Until that Saturday morning when the hospital called our home there was still hope. I knew what the call was as I hurried to the telephone. I was very anxious ... for what. .. I don't know. Then the voice on the other end said, "I'm sorry, your father has expired." A cold chill swept over me and I said "I'll be right there." A few minutes later I was standing next to your stilled body. I knew you were watching from somewhere, I felt your presence, but your body was still. I thought of the night before when I said goodnight to you. I whispered in your ear, "Good-night Daddy, I love you and I want you to know that whatever decision you make, we support you. The decision is yours, father. It's between you and God, and it will be the right decision for you ... " I kissed you on the forehead and sang to you as I did every night before I left you at the hospital ... and now I was singing to you for the last time as your physical body was being transformed. "Onward Christian Soldier, marching on to war, with the cross of Jesus, marching on before. March on soldier, march on home." I know you heard me as you hear me now, and I am happy! 
My thoughts flash back to when I was a little girl of seven. I was going to have my tonsils out the next day and I was afraid. Mother was working and you were putting me to bed. "I'm scared, Daddy," I said. "Is it going to hurt?" You never were a man of many words so your not saying anything didn't upset me. You lay next to me in bed and sang me a song. I fell asleep secure and safe before you finished. "Onward Christian soldiers, marching on to war, with the cross of 
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(c) 
If feasible, return to the places that you and the person frequented or where you had special moments. 

(d) 
Tape-record your memories and play them back. 

(e) 
Write down the meaning of each experience and what of that memory you will take with you into the future. 

(f) 
Visit the resting place of the deceased, alone or with someone else. 

(g) 
Fantasize and write down how you can allow other meaningful relationships to add to your "treasure chest of meaning." View this as a game, i.e. "The Search for Gold (Meaning)." 

(h) 
Role Playing: The counselor and client can interact in role playing or logodrama exercises on how to search for meaning in the future. This could also be another way to reenact the event that has caused the grief, establishing it as concrete or actually happening. It can also reinforce new learning through behavior when focusing on future plans. 


Jesus, marching on before." And this is what we did all of our lives, without even realizing it: we marched on, and we will continue to march on. We marched on when you went to war. We marched on when grandmother died. We marched on and on and on. When Sylvia (a younger daughter of the deceased) had a cerebral hemorrhage and the doctors said she would die, we marched on. Mother and I didn't think we could march on, but you said, "She's not going to die, I don't care what anyone says." We marched on, and Sylvia didn't die. She miraculously lived and marches on today, a strong Christian soldier, enjoying her family, ever faithful to her therapy. She is always growing and recovering. Her life is an example to behold. You, our dear father, gave her this fight and I followed you. We marched on together in procession, in unison, as one. You will always march on, through us in spirit now, but always with us. I'm confident that, as your evolution continues, you march on! 
I remember the day you left for the hospital to be operated on last June ....A friend of yours drove you to the hospital, so mother and I were left behind and as we said goodby at the door, you turned around toward us. Your head was held high. You saluted as a soldier would and said .... "Remember, onward Christian soldiers, marching on ... '' This is how we knew you, this is how we will remember you ... Thank you, father, we will always love you. You will always remain in my heart .... 
The words of the song "Onward Christian Soldiers," has become the symbolic meaning to this woman in remembering her father. 
(In loving memory of Louis Del Guidice at rest February 28, 1981, with love, from your daughter, Mary Ann.) 
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(i) A closure technique is to be used, such as writing a letter or a eulogy to the deceased including the symbolic meaning of the lost person which the griever can now use. (See box) (Note: Logotherapy aims at directing the clients toward achieving reorganization of their lives by reshaping a different gestalt or meaning without the presence of the lost person. The closure technique allows the grieving individuals to symbolically integrate the meaning of the lost person's life into their own. Thus, the lost person has not lived in vain. His or her essence or "gift to life" will continue.) Stage V, Reevaluation and Termination: 
Tasks: The counselor will check to see that the following has happened: 
1. 
Indication that present-day conflicts are resolved in a mutual (counselor/ client) manner. 

2. 
Client expresses optimism about future plans. 

3. 
Client has internalized new attitudes. After this has happened, the counselor moves toward termination. 


In summary, the counselor reviews the entire process with the grieving client and reinforces the progress made by the client. The counselor checks the client's feelings and attitudes about the changes that have taken and are taking place. How personalized and internalized are these changes? The counselor then discusses future goals of the client and gives oral feedback to the client's natural grieving process. This includes presenting the initial problem and the counselor's assessment of the changes that have taken place. In discussing goals, it is important to emphasize realistic expectations. Each personality has certain characteristics that may be limiting or that cannot be changed. With some modification, the characteristics that cannot be changed can be channelled to be constructive and effective. 
The success of logotherapy is primarily based upon Frankl's philosophy of life tested in his personal experiences in German concentration camps. He did not dwell on death. To do this might have been overwhelming. He tried to find meaning in each moment in the face of horrendous and unavoidable suffering. The meaning he found provided him with motivation to search for meaning in life, and with an effective device for survival. He felt somehow "connected to" a larger purpose and thereby found a reason to survive severe deprivation. 
Grief counseling may necessitate short-term or long-term counseling and the use of techniques such as those mentioned in my hypothetical logotherapy counseling process. Logotherapy provides for the regression of the clients and evokes memories of deep past experiences. The meaning that is brought back from remembering can allow the clients to let go of the painfulness of the past, enabling this meaning to enter into the present for use in continued growth. They will be able to see patterns of their life which connect all of life's events within the self. By providing an atmosphere of safety, the relationship between counselor and client becomes a safe point of reference from which the client can progress. We need points of reference, 
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physical objects or symbols to connect with in order to express and allow 
our abstract or spiritual/ creative dimensions to become "real." 
Abstract concepts and symbols can serve as an integrating device enabling 
us to feel "whole." This process will allow us to find meanings 
spontaneously. Using logotherapy as a grief counseling process can help us 
take a meaningful attitude in a situation which itself is meaningless and thus 
allow our search for meaning to continue. 
MARY ANN MANIACEK is a mental health counselor working with Dorothy May, Ph.D., and associates. She is currently completing studies in a Master's Program at Northestern Illinois University in Chicago. 
REFERENCES 
I. Frankl, V.E. The Will to Meaning. New York, New American Library, 1969, p. x. 
2. Kuzuhara, D.K. "Despair and Three Meanings of Hope." in Analecta Frank/iana, Sandra Wawrytko, ed. Berkeley, California, Institute of Logotherapy Press, 1982. 
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International Forum for Logotherapy 
Vol. 5, No. 2, Fall/Winter 1982 
THE "TERRESTRIAL" MEANINGS OF LIFE 
Irvin D. Yalom 
Few clinicians have made any substantial contributions to the role of meaning in psychotherapy, and virtually none have in their published work maintained a continued interest in this area. Viktor Frankl is the single exception; and from the beginning of his career, his professional interest has focused exclusively on the role of meaning in psychopathology and therapy. Although Frankl is aware of the many clinical issues stemming from the other existential ultimate concerns, he maintains in all his work a singular accent on meaning in life. When he speaks of existential despair, he refers to a state of meaninglessness; and when he speaks of therapy, he refers to the process of helping the patient find meaning. 
"Meaning" and "purpose" have different connotations. "Meaning" refers to sense, or coherence. It is a general term for what is intended to be expressed by something. A search for meaning implies a search for coherence. "Purpose" refers to intention, aim, function. When we inquire about the purpose of something, we are asking about its role or function. What does it do? To what end? 
What is the meaning of life? is an inquiry about cosmic meaning, about whether life in general or at least human life fits into some overall coherent pattern. What is the meaning of my life? is a different inquiry and refers to what some philosophers term "terrestrial meaning."• Terrestrial meaning ("the meaning of my life") embraces purpose: one who possesses a sense of meaning experiences life as having some purpose or function to be fulfilled, some overriding goal or goals to which to apply oneself. 
Cosmic meaning implies some design existing outside of and superior to the person and invariably refers to some magical or spiritual ordering of the universe. Terrestrial meaning may have foundations that are entirely secular-that is, one may have a personal sense of meaning without a cosmic meaning system. 
Let me survey the secular activities that provide human beings with a sense of life purpose. They seem right; they seem good; they are intrinsically satisfying and need not be justified on the basis of any other motivation. 
From EXISTENTIAL PSYCHOTHERAPY by Irvin D. Yalom. Copyright (c) 1980 by Yalom Family Trust. By permission of Basic Books, Inc., Publishers, New York. 
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Altruism 
Leaving the world a better place to live in, serving others, participation in charity-these activities are right and good and have provided meaning for many humans. 
In my clinical work with patients dying of cancer, I have been in a particularly privileged position to observe the importance of meaning systems to human existence. Repeatedly I have noted that those patients who experience a deep sense of meaning in their lives appear to live more fully and to face death with less despair than those whose lives are devoid of meaning. Though at this juncture patients experienced several types of meaning, both religious and secular, none seemed more important than altruism. Some clinical cases are illustrative. 
Sal was a thirty-year-old patient who had always been vigorous and athletic until he developed multiple myeloma, a painful disabling form of bone cancer from which he died two years later. In some ways Sal's last two years were the richest of his life. Though he lived in considerable pain and though he was encased in a full body cast (because of multiple bone fractures), Sal found great meaning in life by being of service to many young people. Sal toured high schools in the area counseling teen-agers on the hazards of drug abuse and used his cancer and his visibly deteriorating body as powerful leverage in his mission. He was extraordinarily effective: the whole auditorium trembled when Sal, in a wheelchair, frozen in his cast, exhorted: "You want to destroy your body with nicotine or alcohol or heroin? You want to smash it up in autos? You're depressed and want to throw it off the Golden Gate bridge? Then give me your body! Let me have it! I want it! I'll take it! I want to live!" 
Eva, a patient who died of ovarian cancer in her early fifties, had lived an extraordinarily zestful life in which altruistic activities had always provided her with a powerful sense of life purpose. She faced her death in the same way; and, though I feel uneasy using the phrase, her death can only be characterized as a "good death." Almost everyone who came into contact with Eva during the last two years of her life was enriched by her.When she first learned of her cancer and again when she learned of its spread and its fatal prognosis, she was plunged into despair but quickly extricated herself by plunging into altruistic projects. She did volunteer work in a hospital ward for terminally ill children. She closely examined a number of charitable organizations in order to make a reasoned decision about how to distribute her estate. Many old friends had avoided close contact with her after she developed cancer. Eva systematically approached each one to tell them that she understood their reason for withdrawal, that she bore no grudge, but that still it might be helpful to them when they faced their own death, to talk about their feelings toward her. 
Eva's last oncologist, Dr. L., was a cold, steel-spectacled man who sat behind a desk the size of a football field and typed on Eva's medical record while he talked to her. Though Dr. L. was exceptionally skilled technically, Eva considered changing doctors in order to find someone warmer and more caring. She decided instead to stay with him and to make her final goal in life "the humanization of Dr. L." She demanded more time from him, requested that he not type and that he listen to her. She empathized with his position with patients: how hard it must be to see so many of his patients die-in fact, because of his specialty, almost all his patients. Shortly before she died she had two dreams which she reported both to me and to Dr. L. The first was that he was in Israel but could not muster the resolution to visit the Holocaust museum. In the second dream she was in a hospital corridor and a group of doctors (including Dr. L.) were walking away from her very quickly. She ran after them and told them: "O.K. I understand that you can't deal with my cancer. I forgive you, it's all right. It's perfectly normal you should feel this way." Eva's perseverance won out, and eventually she had the gratification of breaking down Dr. L's barriers and touching him in a deeply human II!anner. 
She was in a support group for patients with metastatic cancer and found meaning until the end of her life in the fact that her attitude toward her death could be of value to many other patients who might be able to use Eva's zest for life and courageous stance toward death as a model for their own living and dying. One of these patients, Madeline Salmon, a marvelous poet, wrote this poem to be read at Eve's memorial: 
Dear Eva, 
Whenever the wind is from the sea Salty and strong You are here. 
Remembering your zest for hilltops And the sturdy surf of your laughter Gentles my grief at your going And tempers the thought of my own. 
"Tempers the thought of my own" expresses beautifully an important source of meaning for so many persons facing death. The idea of being a model for others, especially for one's children, of helping them to diminish or remove the terror of death can fill life with meaning until the moment of death. One extends oneself into one's children and into one's children's children and so on in the great chain of being. Eva, of course, influenced me profoundly and, in so doing, shares in the process by which I find my meaning by passing on her gift to my readers. 
Altruism constitutes an important source of meaning for psychotherapists-and, of course, for all helping professionals-who not only invest themselves in helping patients grow but also realize that one person's growth can have a ripple effect whereby many others who touch on that patient's life are benefited. This effect is most obvious when the patient is someone who has a wide sphere of influence (teacher, physician, writer, employer, executive, personnel manager, another therapist), but in truth it obtains from every patient in that one cannot in one's everyday life avoid innumerable encounters with others. In my own clinical work I try with every patient to make this an explicit area of inquiry; I examine their interpersonal contacts, both intimate and casual; I explore with them what they want from others and what they contribute to the lives of others. 
The belief that it is good to give, to be useful to others, to make the world better for others, is a powerful source of meaning. It has deep roots in the Judeo-Christian religious tradition and has been accepted as an a priori truth even by those who reject the theistic component. 
Dedication to a Cause. "What man is, he has become through that cause he has made his own." Karl Jasper's words indicate another important secular source of life meaning-devotion to a cause. Will Durant, the philosopher and historian, wrote a book entitled On the Meaning of Life, 
which consists of statements by eminent men on their notions of meaning in life. Working for some "cause" is a pervasive theme. In his conclusions Durant states his personal position: 
Join a whole, work for it with all your body and mind. The meaning of life lies in the chance it gives us to produce, or to contribute to something greater than ourselves. It need not be a family (although that is the direct and broadest road which nature in her blind wisdom has provided for even the simplest soul); it can be any group that can call out all the latent nobility of the individual, and give him a cause to work for that shall not be shattered by his death."' 
Many kinds of cause may suffice: the family, the state, a political or religious cause, secular religions like communism and fascism, a scientific venture. But the important thing, as Durant states, is that "it must, if it is to give life meaning, lift the individual out of himself, and make him a cooperating part of a vaster scheme."' 
"Dedication to a cause" as a source of personal meaning is complex. Durant's statement contains several aspects. First, there is the altruistic component: one finds meaning by contributing to others. Many causes have altruistic underpinnings-either they are dedicated toward direct service, or they may be more complex movements whose direction is ultimately utilitarian ("the greatest good for the greatest number"). It seems important, if an activity is to supply meaning , that it "lift the individual out of himself," even though it is not explicitly altruistic. This concept of "self-transcendence" is central to life-meaning schemes and will be discussed shortly. When, however, Durant speaks of a cause "that shall not be shattered by death" or of "becoming a part of something" greater than oneself," he is referring to other issues (for example, death transcendence, the anxiety of isolation and helplessness) rather than to meaninglessness per se. 
Creativity. Just as most of us would agree that service to others and dedication to a cause provide a sense of meaning, so too would we agree that a creative life is meaningful. To create something new, something that rings with novelty or beauty and harmony is a powerful antidote to a sense of meaninglessness. The creation justifies itself, it defies the question What for?, it is "its own excuse for being." It is right that it be created, and it is right that one devotes oneself to its creation. 
Irving Taylor suggests that creative artists who have worked with the greatest personal handicaps and the greatest social constraints (only think of Galileo, Nietzsche, Dostoevsky, Freud, Keats, the Bronte sisters, Van Gogh, Kafka, Virginia Woolf) may have had faculties of self-reflection so highly developed that they had a keener vision than most of us of the human existential situation and the universe's cosmic indifference.• Consequently, they suffered more keenly from a crisis of meaninglessness and, with a ferocity born of desperation, plunged into creative efforts. Beethoven said explicitly that his art kept him from suicide. At the age of thirty-two, in despair because of his deafness, he wrote, "Little kept me back from putting an end to my life. Art alone held me back. Alas, it seems to be impossible for me to leave the world before I have done all that I feel inclined to do, and thus I drag on this miserable life."' 2 
The creative path to meaning is by no means limited to the creative artist. The act of scientific discovery is a creative act of the highest order. Even bureaucracy may be approached creatively. A research scientist who changed fields described the importance and the feasibility of being creative in an administrative position. 
If you go into administration, you must believe that this is a creative activity in itself and that your purpose is something more than keeping your desk clean. You are a moderator or arbiter, and you try to deal equitably with a lot of different people, but you've also got to have ideas, and you've got to persuade people that your ideas are important and to see them into reality ...This is part of the excitement of it. In both research and administration, the excitement and the elation is in the creative power. It's bringing things to pass. Now, I think administration is more exciting than research. 10 
A creative approach to teaching, to cooking, to play, to study, to bookkeeping, to gardeninig adds something valuable to life. Work situations that stifle creativity and turn one into an automaton will, no matter how high the salary scales, always generate dissatisfaction. 
A friend of mine, a woman sculptor, when asked whether she found joy in her work pointed to another facet of creativity: self-discovery. Her work was dictated, in part, by unconscious forces within. Each new piece was doubly creative: the work of art in itself and the new inner vistas illuminated by it. 
This expanded view of creativity was exceptionally useful to a composer who sought therapy because the approach of his fifty-fifth birthday had impelled him to examine his life-a process that led him to conclude that he had contributed little to his field. He had a profound sense of purposelessness and was convinced that none of his efforts would have any lasting value. He sought therapy to increase his professional creativity, knowing at the same time that his talent as a composer was limited. Therapy was unproductive until I expanded the concept of creativity to include his entire life. He became aware of how stifled his life was in many areas. For one thing, he had been locked into an unsatisfying marriage for over thirty years and yet could bring himself neither to change it nor to end it. Therapy forged ahead when we reformulated his initial complaint into a new one: "How could he be creative in fashioning a new type of life for himself?" 
Creativity overlaps with altruism in that many search to be creative in order to improve the condition of the world, to discover beauty, not only for its own sake but for the pleasure of others. Creativity may also play a role in a love relationship: bringing something to life in the other is part of mature loving and of the creative process as well. 
The Hedonistic Solution. A philosophy professor asked members of an undergraduate class to write their own obituaries. One segment of the responses was characterized by such statements as: 
Here I lie, found no meaning, but life was continuously astonishing. or: 
Shed your tears for those who have lived dying
Spare your tears for me for I've died living.' 
The purpose of life is, in this view, simply to live fully, to retain one's sense of astonishment at the miracle of life, to plunge oneself into the natural rhythm of ife, to search for pleasure in the deepest possible sense. A recent textbook on humanistic psychology summed it up: "Life is a gift. Take it, unwrap it, appreciate it, use it, and enjoy it."' 
This view has a long heritage. In the Philebus, Plato presented a debate about the proper goal of every human being. One view argues that one should aim toward intelligence, knowledge, and wisdom. The opposing position is that pleasure is the only true goal in life. This view, hedonism, 
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has had many champions from the time of Eudoxus and Epicurus, in the third and fourth centuries B.C., through Locke and Mill, in the seventeenth and eighteenth centuries, until the present. The hedonists can muster powerful arguments that pleasure as an end in itself is a satisfactory and sufficient explanation for human behavior. One makes future plans and chooses one course over another if, and only if, says the hedonist, one thinks it will be more pleasant (or less unpleasant) for oneself. The hedonistic frame of reference is formidable because it is elastic and can include each of the other meaning schemes within its generous boundaries. Such activities as creativity, love, altruism, dedication to a cause, can all be viewed as important because of their ultimate pleasure-producing value. Even behavior that seems to aim at pain, displeasure, or self-sacrifice may be hedonistic since one may consider it as investment in pleasure. This is an instance of the pleasure principle yielding to the reality principle-to temporary discomfort that will yield future dividends ofpleasure. 
Self-Actualization. Another source of personal meaning is the belief that human beings should strive to actualize themselves, that they should dedicate themselves to realizing their inbuilt potential. 
The term "self-actualization" is a modern reformulation of an ancient concept explicitly expressed as early as Aristotle in the fourth century s.c. in his system of teleological causation-a doctrine of internal finality which postulates that the proper end or aim of each object and each being is to come to fruition and to realize its own being. Thus, the acorn is realized in the oak, and the infant in a fully actualized adult. 
Later the Christian tradition emphasized self-perfection and offered the figure of Christ, the man-God, as a model to be imitated by those seeking to perfect their God-given being. The Imitation of Christ-the fifteenthcentury devotional work by Thomas a Kempis and second only to the Bible in its influence on the faithful-and numerous books on the lives of the saints provided guides for generations of practicing Christians, especially the literate ones, into our own time. 
•in a later section of his book, Yalom describes Frankl's position toward the 'hedonistic solution': "(A) major objection Frankl offers to a nontranscendent pleasure-principle view of human motivation is that it is always self-defeating. The more one seeks happiness, the more it will elude one. This observation ...led Frankl to say, 'Happiness ensues; it cannot be pursued.' ... Pleasure is thus not the final goal but is a by-product of one's search for meaning.'' 
In today's secular world "self-actualization" is enmeshed in a humanistic, individualistic framework. Self-actualization has particular significance for Abraham Maslow who holds that one has within oneself proclivity toward growth and unity of personality and a type of inherent 
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blueprint or pattern consisting of a unique set of characteristics and an automatic thrust toward expressing them. One has, according to Maslow, a hierarchy of inbuilt motives. The most fundamental of these-from the standpoint of survival-are physiological. When these are satisfied, the individual turns toward satisfaction of higher needs-safety and security, love and belongingness, identity and self-esteem. As these needs are met, then the individual turns toward satisfying self-actualizing needs which consist of cognitive needs-knowledge, insight, wisdom-and esthetic needs-symmetry, congruence, integration, beauty, meditation, creativity, harmony. 
Self-actualization theorists propose an evolutionary morality. Maslow, for example, states "the human being is so constructed that he presses toward fuller and fuller being and this means pressing toward what most people would call good values, toward serenity, kindness, courage, honesty, love, unselfishness, and goodness."9 Maslow thus answers the question What do we live for? by stating that we live in order to fulfill our potential. He answers the trailer question What do we live by? by claiming that the good values are, in essence, built into the human organism and that, if one only trusts one's organismic wisdom, one will discover them intuitively. 
Thus, Maslow takes the positon that actualization is a natural process, the basic organismic process in the human being, and will take place without the aid of any social structure. In fact, Maslow views society as an obstruction to self-actualization because it so often forces individuals to abandon their unique personal devlopment and to accept ill-fitting social roles and stifling conventionality. I am reminded of an old psychology test where I once saw two pictures, juxtaposed. One showed children playing with one another in all the freshness and spontaneity of childhood exuberance and innocence; the other, a crowd of New York subway travelers with vacant stares and mottled gray faces dangling lifelessly from the subway straps and poles. Under the two pictures was the simple caption: "What happened?" 
Self-Transcendence. The last two types of meaning (hedonism and selfactualization) differ from the previous ones (altruism, dedication to a cause, and creativity) in one important aspect. Hedonism and selfactualization are concerned with self, whereas the others reflect some basic craving to transcend one's self-interest and to strive toward something or someone outside or "above" oneself. 
A long tradition in Western thought counsels us not to settle for a nonself-transcendent purpose in life. To take one example, Buber, in his discussion of hasidic thought, notes that, though human beings should begin with themselves (by searching their own hearts, integrating themselves, and finding their particular meaning), they should not end with 
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themselves. 2 It is only necessary, Buber states, to ask the question "What for? What am I to find my particular way for? What am I to unify my being for? The answer is: "Not for my own sake." One begins with oneself in order to forget oneself and to immerse oneself into the world; one comprehends oneself in order not to be preoccupied with oneself. 
"Turning" is a crucial concept in Jewish mystical tradition. If one sins and then turns away from sin, toward the world and toward fulfillment of some God-given task, one is considered uniquely enlightened, standing above even the most pious holy man. If, on the other hand, one continues absorbed with guilt and repentance, then one is considered to be mired in selfishness and baseness. Buber writes: "Depart from evil and do good. You have done wrong? Then counteract it by doing good."2 
Buber's essential point is that human beings have a more far-reaching meaning than the salvation of individual souls. In fact, through excessive preoccupation with gaining an advantageous personal place in eternity, a person may lose that place. 
Viktor Frankl arrives at a similar position and expresses strong reservations about the current emphasis on self-actualization. It is his view that excessive concern with self-expression and self-actualization thwarts genuine meaning. He often illustrates this point with the metaphor of a boomerang that returns to the hunter who threw it only if it misses its target; in the same way human beings return to self-preoccupation only if they have missed the meaning that life has for them. He illustrates the same point with the metaphor of the human eye which sees itself or something in itself (that is, it sees some object in the lens or in the aqueous or vitrous humor) only when it is unable to see outside of itself. 
The dangers of nontranscendent posture are particularly evident in interpersonal relationships. The more one focuses on oneself for example, in sexual relationships, the less is one's ultimate satisfaction. If one watches oneself, is concerned primarily with one's own arousal and release, one is likely to suffer sexual dysfunction. Frankl-quite correctly, I believe-feels that the contemporary idealization of "self-expression" often, if made an end in itself, makes meaningful relationships impossible. The basic stuff of a loving relationship is not free self-expression (although that may be an important ingredient) but reaching outside of oneself and caring for the being of the other. 
Maslow uses different language to convey the same concept. In his view, the fully actualized person (a small percentage of the population) is not preoccupied with "self-expression." Such a person has a firm sense of self and "cares" for others rather than uses others as a means of self-expression or to fill a personal void. Self-actualized individuals, according to Maslow, dedicate themselves to self-transcendent goals. _They may work on largescale global issues-such as poverty, bigotry, or ecology-or, on a smaller scale, on the growth of others with whom they live. 
Self-transcendence and the life cycle. These life activities that provide meaning are by no means mutually exclusive; most individuals derive meaning from several of them. Furthermore, as Erik Erikson long ago theorized5 (a theory that has been thoroughly corroborated by the adult life cycle research in the 1970s' '), there is gradual evolution of meanings throughout an individual's life cycle. Whereas in adolescence and early and middle adulthood one's concerns are centered on self as one struggles to establish a stable identity, to develop intimate relationships, and to achieve a sense of mastery in professional endeavors, in one's forties and fifties one passes (unless one fails to negotiate an earlier developmental task) into a stage where one finds meaning in self-transcendent ventures. Erikson defined this stage ("generativity") as "the concern in establishing and guiding the next generation," 5 and it may take the form of specific concerns for one's progeny or, more broadly, in care and charity for the species. 
George Vaillant, in his splendid longitudinal study of Harvard undergraduates, reported that during their forties and fifties successful men "worried less about themselves and more about the children." One representative subject stated at fifty-five: "Passing on the torch and exposure of civilized values to children has always been of importance to me, but it has increased with each ensuing year." Another: 
The concerns I have now are much less self-centered. From 30-40 they had to do with too many demands or too little money, whether I could make it in my profession, etc. Past age 45 concerns are more philosophical, more long term, less personal ... I am concerned about the state of human relations, and especially of our society. I am concerned to teach others ·as much as I can of what I have learned. 
Another: "I don't plan on leaving any big footsteps behind, but I am becoming more insistent in my attempts to move the town to build a new hospital, support schools, and teach kids to sing." 11 
The emergence of self-transcendent concerns is reflected in the professional careers of several of Vaillant's subjects. 11 One scientist had pioneered, in his twenties, a new method of making poison gas; at fifty he chose to research methods of reducing air pollution. Another had, during his youth, worked for the military industrial establishment and helped calculate the blast radius of atomic warheads; at fifty he pioneered a college course in humanism. 
A major longitudinal study at Berkeley, California, conducted by Norma Haan and Jack Block compared thirty-year-old and forty-five-year-old individuals to themselves as adolescents and arrived at similar findings. Altruism and other self-transcendent behavior increased over time. Individuals at forty-five were "more sympathetic, giving, productive and dependable"than they were at thirty. 11 
Much developmental research has dealt primarily with the male life cycle 
IOI 
and has not taken special circumstances in the lives of women sufficiently into consideration. Recent feminist scholarship has offered an important corrective. Middle-aged women, for example, who earlier in their lives devoted themselves to marriage and motherhood, seek different meanings to fulfill than their middle-aged male counterparts. Traditionally women have been expected to meet the needs of others before their own, to live vicariously through husbands and children, and to play a nurturing role in society as nurses, volunteers, and purveyors of charity. Altruism has been imposed upon them rather than freely chosen. Thus, at a time when their male counterparts have achieved worldly success and are ready to turn to altruistic considerations, many middle-aged women, are for the first time in their lives concerned with themselves rather than with others. 
IRVIN D. YALOM, M.D. is professor ofpsychiatry at Stanford University School ofMedicine. 
REFERENCES 
1. 
Brennecke, J. and R. Amick. The Struggle for Significance. Beverly Hills, Clencoe Press, 1975, pp. 9-10. 

2. 
Buber, M. "The Way of Man According to the Teachings of Hasidism," in Religion from Tolstoy to Camus, W. Kaufman, ed. New York, Harper Torchbooks, 1961, pp. 425-441, 437. 

3. 
Durant, W. On the Meaning of Life. New York, Ray Long and Richard R. Smith, 1932, pp. 128-129. 


4, Encyclopedia of Philosophy, vol. IV. P. Edwards et al, ed. New York, Macmillan and Free Press, 1967, pp. 467-478. 
5. 
Erikson, E. Childhood and Society. New York, W.W. Norton, 1963, pp. 247-274, 267. 

6. 
Frankl, V.E. The Will to Meaning. New York, World Publ. Co, 1969. p. 38. 

7. 
Koestenbaum, P. Is There an Answer to Death? New York, Prentice-Hall, 1976. pp. 37-38. 

8. 
Maddi S. The Stenuousness ofthe Creative Life, in Perspectives in Creativity, Taylor and Getzels, eds. Chicago, Aldine, 1975, pp. 173-190. 

9. 
Maslow, A. Toward a Psychology of Being. N.J., Van Nostrand, 1962, p. 147. JO. Roe, A. "Changes in Scientific Activities with Age," Science, 150, 313-318, 1965. 


II. Vaillant, G. Adaptation to Life. Boston, Little Brown, 1977, pp. 228,232, 343, 330. 
12. Van Andics. Suicide and the Meaning of Life. London, William Hodge, 1947, p. 178. 
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International Forum for Logotherapy 
Vol. 5, No. 2, Fall/Winter 1982 
Logotherapy in U.S. UniversitiesA Survey 
Bianca Z. Hirsch and Vera Lieban-Kalmar 
The Board of Directors of the Logotherapy Institute sponsored a survey and requested an investigation to determine the extent of logotherapy involvement in United States universities. A one-page questionnaire containing ten items was designed which covered the following aspects: (a) classroom teaching, (b) clinical setting, (c) organizational level. 
The intent of the survey was to use the results for planning programs and future communications between the Institute and various departments of schools of higher learning. 
PROCEDURES 
The mailing list of the First World Congress of Logotherapy was used to mail 1,500 questionnaires to departments of philosophy, sociology and psychology. Inasmuch as the mailing was limited to these departments, the survey was considered a pilot study with the intent of sending future mailings to include other departments, such as: Education, Religion, Health Care Services, including Mental Health, Industry and Management, Schools of Medicine and Nursing. 
Sample questions were evaluated by a panel of experts in the fields of philosophy, sociology, and psychology. Due to a limited time-frame and budget allotment, it was decided to sample these three departments in one mailing only. Follow-up consisted of acknowledgement and expression of appreciation to the participants. 
RESULTS 
Research on Sampling Techniques of questionnaires and surveys indicates that one-time-mailing usually yields a 4% return. Our study yielded a 5% return. Of these 5%, 75% gave a positive reply indicating an interest and/or an application of logotherapy. The predominant application was in the area of teaching as subject matter and secondly as a therapeutic technique in a clinical setting. 
Responses indicated that there was no organizational back-up for the use of logotherapy in universities and colleges inasmuch as a need for additional contact and material was requested from the Institute of Logotherapy. 
CONCLUSION 
More than half of the participants requested professional contact with the Institute of Logotherapy through meetings, symposia, and workshops. The survey generated an awareness of a variety of publications available through the Institute and of current developments in the field of logotherapy. 
FUTURE IMPLICATIONS 
(1) 
Questionnaire should be sent to an extended list of departments in institutions of higher learning. 

(2) 
A network of regional centers should be established for the purpose of dissemination of information and materials on logotherapy. 


SURVEY ANALYSIS: 
Total Surveys sent out: 1500 Total returns: 76 = 5% Total positive returns: 57 = 75% Total negative returns: 19 = 25% 
Each item equals: 1.75% 
Applying logotherapy: to teaching: 70% 
in therapeutic relationships: 24.5% 
in counseling: 28% 
to own life: 36.8% 
in course of own methodology: 29.8% 
in course of comparative therapies: 42% Teaching logotherapy as part of: the psychology curriculum: 43.8% 
the philosophy curriculum: 21 % 
Developed course of study where logotherapy has a part: 28% 
Willing to share a copy of such a course of study: 19.3% 
For how many years has logotherapy been incorporated in the curriculum: 
7, no reply, but teach a course 
28, replied, 7.5 years average. 
Would like more material on logotherapy: 77%. 
lf\A 
Interested in: meetings: 45.5% logofairs: 25.5% symposia: 31.5% 
Most used book: Man's Search for Meaning: 54.3% Psychotherapy and Existentialism: 14%. 
BIANCA Z. HIRSCH, Ph.D. is a school psychologist in the San Francisco school system, and a member of the Board of Directors of the Institute of Logotherapy. VERA LIEBAN-KALMAR, Ed.D., is consultant to the San Jose High School District and secretary of the Board ofDirectors of the Institute of Logot herapy. 
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International Forum for Logotherapy Vol. 5, No. 2, Fall/Winter 1982 
DIALOGO GROUP WORK AND SOCIAL 
CHANGE 
Norman N. Goroff 
This paper focuses on the ability of dialogo group work to provide participants with opportunities to deal with their pain, and to begin the process of social change. The first major premise of our theories and work is that most of the pain we human beings experience is directly attributable to how we have organized our lives together. Frankl discusses unavoidable pain with the recognition that much pain we experience is avoidable. Mourning the death of another human being is an example of unavoidable pain. Suffering the pain of discrimination is a social condition human beings have created and can thus eliminate. 
That the social world is the creation of human beings is the second major premise. Nothing in this social world is preordained, predestined, inevitable, or created by "forces" beyond the human being-the existing good and evil is the result of human actions. No social arrangements devised by people are the inevitable consequence of either the psychic or biological makeup of the species. We can look at the various forms, structures, and patterns of human socieities throughout the ages to recognize the truth of this assertion. 
Human beings create all the concepts and symbols used in human communication. Inherent in almost all concepts or symbols are evaluative connotations. Only a few appear to be neutral. Most concepts tend to communicate either a preference for, a positive valuation of, or a negative response. In interaction with other human beings, we learn language concepts with which we begin to organize our understanding of the social world and our place in it. We learn to think utilizing concepts. We learn to think of ourselves utilizing concepts. Because concepts have evaluative components, we tend to see ourselves and the social world in an evaluative framework. 
THE CONSEQUENCES OF ACTIONS 
History is made by human beings interacting in the world. We each make history, but are restrained in our actions partly because people who preceded us took actions, the consequences of which we are having to deal 
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with. We are all born into a world that our forebears have helped to structure. People born after Hiroshima have had to cope with the reality of atomic bombs, atomic energy, and radioactive waste; people born before Hiroshima did not have that concern. People living today have to live with the consequences of action taken more than forty years ago. Nevertheless, we can collectively decide what we want to do with atomic power, atomic bombs, and atomic waste. We cannot turn the clock back to that time before the atomic bomb, but we can decide what we want to have happen now. 
Thus we make decisions which will affect the lives of human beings unborn for many generations. If we collectively decide to continue to produce waste which will remain radioactive for at least 250,000 years although we have no way to store the waste without contaminating the earth, we are asking the generations yet unborn to gamble with their gene pool, with the likelihood of increased cancer and possible human mutations. The future generations will make their history within the restraints of our collective decisions. 
In our society people are discriminated against because of race, sex, and age. There is little disagreement that discrimination causes a great deal of emotional and psychological pain. The individual experiencing that discrimination feels the pain and must find some way to make sense of the experience without allowing the negative evaluation inherent in discrimination to become part of his or her self-concept. Nevertheless, it is equally important for the rest of the human species to assume our rightful responsibility for the presence of discrimination. It is we who discriminate. It is we who cause the pain. It is not an individual deficiency to be a person of color, because we are all of color; nor to be a woman; nor to be old because longevity is the goal most of us want to achieve. 
We human beings organize to create the resources we need for human survival. This is essentially a social process because we need one another to collectively create and distribute the food, clothing, shelter, and other necessities required for human existence and survival. The process of distributing these resources, which influence significantly the life changes of people, is part of the "body politics" because power is part of the decisionmaking process which allocates the resources. 
The allocative decisions are supported by the production of ideas which frequently provide a "rational" basis for the decisions. Thus, high priority is given to the concept of meritocracy which posits that individuals in our free and open society are rewarded on the basis of merit. People who have what it takes to get ahead, will get ahead. Those who don't have what it takes, get what they deserve. 
Another critical concept which tends to support the allocative decisions is 
individualism, in which the individual is viewed in an atomistic fashion, competing against others for resources. A consequence of this mystical individualism is to destroy the community of humanity which is essential for individual growth and development and the survival of the species. 
Thus, most of the ideas which comprise the social world have been created within the general context of the conditions of the time in order to make sense of these conditions. 
REDEFINING REALITY 
Dialogo group work is to help the participants redefine reality so that they are able to differentiate between pain caused by our social world and pain resulting from some "intrapsychic" conflict. In working with depressed people I have found what appears to be a universal phenomenon which results in much unnecessary pain. Depressed people feel that they are inadequate, they have a negative evaluation of themselves. This selfnegation tends to focus attention on their "inner life" as the cause for the depression. They therefore experience the pain of depression plus the pain of self-negation. This self-negation is, in a large part, responsible for many of the problems and pains which permeate our culture and have become part of our consciousness. 
One aspect of redefining social reality is to help people change their consciousness. Suggesting that people in the group might want to share how they feel about themselves while they are depressed inevitably elicits responses indicating feelings of self-negation. I suggest they think about how it came to pass that almost all feel badly about themselves when they are depressed. Discussions that follow frequently focus attention on how they "ought to be." The myth of "the mature person who has it all together" and thus does not experience the pain of depression becomes the idolized image which cannot be achieved. The recognition of how we have been taught to blame ourselves for our pain begins the process of finding a new definition of social reality which provides opportunities for the participants to restructure their consciousness. 
Restructuring our consciousness includes the recognition of how much of the pain is caused by the way we humans have structured our social world. We develop agreement that injustices can never be seen as part of an "unchangeable condition" because this would indirectly legitimize injustice. Since injustice is created by the way we humans respond to one another and how we allocate life chances, we can and must change to eliminate injustice. 
Frequently, the focus on self-deficiencies distorts the reality. We tend to blame ourselves as the cause of our pain rather than examine how we have organized ourselves. In one group, a woman came in, very depressed. She 
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had spoken to her two sons who were with their father in California. He had obtained custody of them after the divorce. The woman shared with us how she felt about herself, how she was "mixed up," and that the divorce had created a great deal of pain for her. She told of going to see her minister before the divorce and his referring her to a therapist. After several months of seeing the therapist, she was sued for divorce by her husband who sought sole custody of the children on the grounds that she was emotionally unfit to be a mother, citing her visits for professional help. The minister and therapist were ready to testify that she was indeed unfit. Upon hearing this I became incensed at the injustice and at the betrayal by the "benevolent helpers." I immediately told this to her and the others in the group. There followed an hour of clarification and nurturing by all of us of each other. 
The next week the woman told the group she was going to California to visit her sons and to inform her husband that because he was cohabiting with another woman, she was prepared to return to court and sue for sole custody on the grounds that he was providing the sons with an unfit environment. She cited a Supreme Court decision as a precedent for her actions. 
Several weeks later she told the group that when she stopped blaming herself for her pain, she was able to get a clearer picture of what had happened and was able to mobilize herself to do what she felt needed to be done. It was the nurturing as well as the clarification that helped her. 
In dialogo group work, "the helper," "the therapist," "the worker" whatever designation is used-must become a part of the group. The therapists must be able to share with the other participants their own personal concerns and to accept the help that others have to offer. It is a tested phenomenon that one is helped as one helps another; one is nurtured as one nurtures another. 
One afternoon I arrived at the dialogo group mourning the death of a person with whom I had worked for many years and whom I had intended to call many times, but had not. I shared with my friends the pain I was experiencing. The death of my friend represented neither an individual deficiency nor a socially created pain, but was an example of "unavoidable suffering" which will always be present as long as human beings care for one another and human beings die. We recognized the difference between unavoidable suffering (the death) and avoidable suffering as the consequence of my not having visited my friend in time. The discussion focused on my feelings of regret for failing to call the person even though I had frequently intended to do so. 
The next week, one of the members told us of her visit to an aged aunt who was living in a residence for older people. The aunt was ninety-two years old and the member had not visited her (although she had intended to) 
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for eighteen years. She recognized how much unnecessary pain had been caused by her feelings of regret in not acting on her intentions to make contact and she did not want to have to cope with any further guilt and regret. In addition, she stated she had a delightful visit and learned much about the family history. 
REIFICATION THROUGH ROLES 
A great deal of pain is caused by the relatively reified way we have structured social relationship into "roles." Many groups discuss "roles" as defined by others. I am reminded of the statement by John P. Diggins: 1 "The completely socialized person whose entire life is absorbed by his/her social role is another example of how human consciousness can be lost to forces outside of the self, only now reification is not associated with commodities but with society itself. Reification operates in society by endowing ontological states to social roles. The person's identity, personality and selfhood are achieved through the fulfillment of a role that is detached from human intentionality, preformed by institutions, class systems, and cultural habits. People in society do not have lives, they only have social functions, and their functions are lived out through mere mimetic repetitions of the prototypical action embodied in roles." 
A situation which comes to mind in working with people where the reification of social roles has created considerable and avoidable pain, is the role of women and the aged. Women who feel trapped and dehumanized by the apparent rigidity of their social roles are frequently depressed. The feeling that they lack any significant control over their lives results in substantial pain. The feminist movement has provided many women with options which create the beginnings of a redefinition of themselves as persons. However, a lifetime of believing "the truth of the ideas of social roles" is not easy to overcome, particularly where there is increasing evidence that there is a concerted attack on the woman's movement by the politically conservative portion of the population. 
The current attack on the "feminist movement" highlights an important aspect of a system of social relationship, namely power. The attempt by some women to alter the social-role relationships required a change in power relations. The threat to a real or fancied power position has activated those who feel they risk the loss of power. 
In working with people in groups, the issue of power must be addressed in a forthright manner. In conventional wisdom, i.e., "cultural definitions," the therapist is vested with considerable power in the role, by the institutional context that tries to "legitimate" the therapist. 
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Most people who seek therapy have accepted the "individual deficiency" explanation for their pain and expect the therapist to make them "better." They frequently want the therapist to take responsibility for them. I refuse to take responsibility for others and tell it to them immediately. ''What are you going to do for me?" is their challenge. I respond that I intend to do nothing for them, but that I hope we can do things together that might help us all. It is impossible to respect an individual's dignity, worth, and integrity and take on responsibility for the person. "But you're the therapist!" 
"I am I and not a role," is my reply. Thus begins a process that is essential to every group-establishing what each of us means to the other and how we see one another and react to one another. IfI accept the role of therapist, what is your role and is that how you really see yourself? These questions become part of the dialogue. I can recognize and empathize with the pain people feel, but I can not and will not accept them in a subordinate relationship to me. 
My refusal to take the power that members want to give to me does not necessarily mean that they want to retain it for themselves. In the process of the group the issue of each of us being responsible for ourselves, and to each other, is one that needs to be resolved. I use a number of "rules of thumb." I will not do anything for anybody that they can and must do for themselves. IfI were to do for them, my action says that I think they are not capable people. I will not interpret people's behavior-I will only respond by telling them how I feel or think about what they have said or done. Interpretations communicate that "I know better than you what you mean"-they are a manifestation of a desire for power. Interpretations are based on theoretical frameworks which create the illusion of knowing when the goal of human interaction is understanding. Knowing frequently prevents understanding. 
My responsibility to my fellow human beings in the group is to try to understand them and to share with them my own perceptions of the world. In the process I try to make clear that my perceptions are neither better nor worse than theirs . I rarely use the Socratic dialogue; rather, I share my views directly with members in conversation with each and thus with all. A basic component of being with people in groups is that you are in 
conversation with all. 
HUMAN INTERRELATIONSHIPS 
The ensuing process is what I call "negotiating identities." How do we see one another, how do we feel about one another, how much do we know one another as persons? These are critical issues which the people in the group must resolve before any work can be done. For heuristic purposes, one may conceive of the range of possible resolutions from the "it-it" to the 
Ill 
"I-thou" poles. In the "it-it" relationship, the participants relate to one another as role incumbents, i.e., therapist-patient, patient-patient, manwoman, old-young. We relate to one another as social roles, sex roles, age roles, with all the prescribed behavior entailed in those roles. In the "I-thou" relationship the participants have been able to transcend the roles and have touched one another as individual and unique people. 
An unanticipated consequence of approaching the "I-thou" polarity is to call into question what the participants had taken previously for granted-the reified social roles which had structured and restricted much of their living. Thus the process of changing the consciousness of the individual is under way. 
An essential component of social change requires the changing of people's definition of themselves and the social world. This redefinition is necessary in order to bring into question the prevalent idea that the current structure is inevitable and thus unchangeable. 
The process of changing definitions is identical to some of the processes described by Frankl in the practice of logotherapy: he assists people to find meaning in an event by helping them modify their attitude toward the event and its meaning. The case of the man whose wife died is an example of this process. 2 The case of the woman with the crippled boy whose younger child died is another example.2 
Although Frankl has heretofore focused on the usefulness of a change of attitude in helping people find meaning in the events of their lives and thus overcome their spiritual despair, the same process is essential to effect social change. A modification of attitude is an essential component of social change, but is not social change until the new awareness is translated into concrete action. 
The group can and does provide the arena for change as well as the consequences of change. As the participants successfully approach the "I-thou" polarity, a negotiating of identities, they are able to experience relationships which are markedly different from those of most of their dayto-day living. They experience a sense of community with fellow human beings based on caring for one another and shared responsibility to one another. This demonstrates that the impersonal, uncaring relationships that characterize much of the formal system that has evolved today is not inevitable. The group provides the arena to show that change is possible. This experience is to provide the participants with the joys of nurturing that the shared human community is able to provide. We thus experience that which is possible and provide the criteria for what can be achieved-a human community. 
An important aspect of helping group members change their consciousness and their behavior is to provide them with opportunities to get beyond the past without blaming themselves for not knowing better. They move from feeling the victims of forces beyond their control to 
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accepting responsibility for actions here, now, and in the future. One colleague described this as "forgiving ourselves for our previous beliefs" rather than belittling ourselves. 
As the participants work on a consensus regarding how they see one another, the activity leads them to question "the conventional wisdom" that is contained in their definitions of the world. 
Although all groups of people are different, a number of common themes emerge during our interaction. As people experience changes in their definition of the world and assume responsibility for their actions, they frequently meet with people and situations outside the group who do not see reality in the same way as they do. These encounters may create tension. The group must become a source of nurturing and support for those who wish to change the world outside the group. They recognize that change is a process and not an event, and that during the process they will experience joys and disappointments they will want to share with their friends. 
In dialogo group work, we have the opportunity to come to grips with the nature of authority. We move away from the basically irrational authority vested in a position, to the rational authority vested in competency. As we move from a dependence on others to an interdependence among ourselves, we also have the opportunity to examine the strong moral imperative that obedience to authority has been vested in our culture. We examine together how "honoring our parents" becomes "obeying our parents," which in turn becomes generalized to obey those in authority. The most effective way to honor our parents is to live life, because that is what they gave us, and we do them honor by utilizing the opportunity to the fullest. 
To the degree that we have successfully approached the "I-thou" polarity in the group, we have developed a collectivity in which one participant encounters the other as a person. The commitment is not merely to selfexpression, but to a common good. In such a group, leadership vested in an individual becomes mute. We see leadership as those actions by individuals which enable us to do the work we have come together to do. Leadership is not institutionalized in a role but in action. Thus, as with authority, leadership is related to competency to help ourselves. 
The experience has frequently been described as a leaderless group. However, what we become is a group without a "head" or "role" but not without "leaders" because at one time or another, each member of the group performs leadership acts. 
One difficult belief to overcome is related to competition. The pursuit of gains, real or imaginary, at the expense of others, contributes to the impersonality, the lack of caring, and the tendency to abuse power and authority. In groups, the tendency to compete frequently mani fcsts itself as a "fear of being judged negatively" by the others in the group. The need to be always competent and to have one's best foot forward may prevent a person from taking "risks." As group participants become aware of the 
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debilitating consequences of competition, attention is focused on the validity of competition as one of the organizing principles of our lives. As we become a group where we are encountering others as "thous" we recognize that the purpose of our being together is to understand and not judge. 
The participants understand that being part of a dialogo group provides them with the opportunity to experience a variety of relationships, a feeling of human community, a mutual nurturing, a confirmation of their dignity, worth, and integrity, an opportunity to have their belief system challenged, changed, or reinforced. All these are essential prerequisites for the task of changing the world to a humane and human place for human beings. At times the group may collectively engage in activities designed to effect change in the immediate environment; most frequently, however, the group provides the participants with the wherewithal to effect changes in other parts of their world. Collectively and cumulatively, we can humanize the world. 
NORMAN N. GOROFF, Ph.D., is professor of Social Work at the University of Connecticut, Hartford, and was the on-site chairman for the Second World Congress of Logotherapy at Hartford. 
REFERENCES 
I. Diggins, John "Reification and the Cultural Hegemony of Capitalism: The Perspective of Marx and Veblen." Social Research. 44, (2), Summer 1977. 
2. Frankl, Viktor E. Psychotherapy and Existentialism. New York, Simon and Schuster, 1967. 
I 14 
TRANSFERENCE AND COU NTERTRANSFERENCE IN LOGOTHERAPY 
Geroge A. Sargent Ill 

Transference in classical analysis is a resistance that develops in the working relationship between therapist and patient. The patients transfer to the therapist their feelings from unconscious representations of earlier important figures in their lives, such as mother or father. The patient "knows" how the therapist feels toward him or her, a distortion that is particularly easy to project onto the blank screen of the classical analyst. (To enhance the projective process, the early analysts developed procedures that sometimes even called for patient and therapist to be looking in different directions. Prone patients looked at the ceiling or closed their eyes, therapists often sat out of sight behond their analysands, or faced another direction. Offices were barren of personal memorabilia which might intrude on the patient's transferred image of the therapist's world.) 
Working together in therapeutic alliance, the therapist and patient analyze these transferred feelings and imaginings. t\.s patients become more able to recognize the displaced feelings and understand their origins, they see the therapist as a real person and deal with him in more realistic terms. The patients are then more able to understand the distortions of reality they have carried into their relationship with the world, and relate to other 'objects' (people and situations) on a more realistic basis. This transference is at the same time a key problem and a key to the problems presented by the patients. From the standpoint of logotherapy, the most disheartening aspect of these considerations is the way in which the theoretical formulation of transference provides a rationale for the therapist to be a nonperson, to be non-selfdisclosing, and non-risking, particularly in the earliest stages of therapy. 
Countertransference is the term describing those feelings generated in the therapist, or evoked in the therapist by the patient, through which the therapist transfers important figures onto the patient. In classical analysis, countertransference feelings are not to be shared with the patient but with the therapist's therapist. This method of dealing with countertransference again distresses the logotherapist because it reinforces a one-way sharing-patient to therapist. 
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Other schools of therapy have described the phenomenom of transference with different terminology. In Gestalt it is referred to as "unfinished business," or "distortion of contact." In Transactional Analysis transference issues are often part of "old tapes" or "scripts." Behaviorists speak of early learned "behavioral sequences" or "habit patterns." 
Existentialists decry the loss of true encounter when any impediment deadens the lively interaction between two unique individuals in a present situation. They, more than any other school, underline the importance of the therapist risking a real encounter with the patient, person to person, face to f,ace. 
THE EXISTENTIAL APPROACH 
Logotherapy is an existential approach to psychotherapy. For the patient to grow and risk, the logotherapist must also be willing to risk by being a real person in the "here and now" of the therapeutic encounter. In this sense, then, the phenomenon of transference in logotherapy is not interpreted so much as interrupted by therapist's realness and congruence. The personhood of the therapist challenges the feelings that are being transferred indiscriminately by the patient. Not only is the blank screen no longer blank, but also the screen is no longer just a passive two-dimensional plane on which to project images and feelings. The therapist, an alive, valuing, confronting human being, is not willing to be experienced in this way. He considers it a devaluation of himself and the patient. The therapistpatient face to face confrontation challenges the development of transference at its onset. 
But logotherapy is also more than an existential approach to psychotherapy. It is a theory of human nature and a philosophy of life. A blank-screen therapist can avoid disclosing his metaphysics to his patients; the logotherapist can not. Realness and congruence do not stop at the level of disclosure of feelings, and no therapist operates without an implicit meaning system, a set of biases and beliefs. The system may be more or less organized, that is, laden with conflicting ideas or fully integrated and cohesive, but it is present nonetheless. It is not the biases and beliefs which contaminate therapy but therapists' self-deception that their biases can be kept from their patients. 
To the extent that the formulations of transference and countertransference provide a rationale for any therapist to be non-selfdisclosing and nonrisking, they are counterproductive to the logotherapeutic effort. The logotherapist is concerned, above all, with helping patients find the meanings and purposes they are searching for in their daily lives. For the logotherapist to withhold himself as a person is to withhold his own belief 
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system, to withhold risking the exposure of his theory of human nature and his philosophy of life in action. This necessary modeling and openness about the therapist's biases does not mean he is imposing his values and meanings on the patient-just the opposite. But there exists no effective therapist who does not influence. Facing the full personhood of the therapist allows the patients to confront their imagined, frozen view of the therapist with the reality of the therapist as a valuing human being engaged in the process of becoming. 
To the extent that the concept of transference enables the logotherapist to realize that the patients' views of the world as meaningless could be a displacement, it can be useful. Messages that life is absurd and devoid of meaning are often learned early from parents and significant others in childhood. These messages may be verbal or nonverbal, learned from watching how mother and father lived, as well as from listening to what they said about living. Patients who transfer their residual feelings of meaninglessness onto their therapists, or onto all new situations and individuals, need to be confronted with the reality of the potential meaningfulness of life at every moment. One depressed and cynical patient learned one day, after having been compassionately embraced by a woman group member that, as he put it, "people can care, people can do things for others even when there is nothing in it for themselves." This irreversible learning came from her action and authenticity, not from technique. His transference of learned meaninglessness was confronted with genuineness, and he had to open his eyes, for the first time as an adult, to the real possibilities for contact and caring that existed all around him. 
USEFULNESS OF COUNTERTRANSFERENCE 
Similarly, the concept of countertransference can be useful to aspiring logotherapists if it makes them more aware of their transference onto their patients of their hopelessness, cynicism, or existential vacuum. I remember a therapist I saw only briefly a long time ago. "George," he said, "you must realize that the world is a joke. There is no justice, everything is random. Only when you realize this will you understand how silly it is to take yourself seriously. There is no grand purpose in the universe. It just is. There's no particular meaning in what decision you make today about how to act." 
There is no question in my mind that he was wrong, and I immediately tried to convince him how wrong he was, even about himself. Technically, he was a fine therapist, and in his behaviors he lived his life as if he understood exquisitely how meaningful were his actions and reactions in the world. He cared deeply for others and acted with great responsibility with 
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his patients. Verbally and intellectually, however, he was no logotherapist. His counter-transference contaminated our current meaningful encounter, and I hope his therapist (and his patients) eventually helped him recognize and correct this displacement of meaninglessness. It was as if his sense of purpose and meaning were unconscious to himself, or at least outside his current awareness. 
Frankl addresses this essential problem without using the language of transference. His term "unconscious God," however, "in no way implies that God is unconscious to himself, but rather that God may be unconscious to man and that man's reaction to God may be unconscious."' If there is an unconscious God in each of us, we must become aware of our spiritual countertransference to our patients-it may help us correct our conscious verbalizations so that we convey congruently, by word and action, our belief in the ultimate meaningfulness of life. This is the essential characteristic of the logotherapist. 
GEORGE A. SARGENT Ill, Ph.D., is a family therapist in private practice and a Core Faculty member at National University in San Diego, California. 
REFERENCES 
I. Frankl, Viktor E. The Unconscious God. New York, Simon and Schuster, 1970, p. 62. 
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International Forum for Logotherapy 
Vol. 5, No. 2, Fall/Winter 1982 
DEREFLECTION IN FAMILY THERAPY WITH SCHIZOPHRENIC CLIENTS 
James E. Lantz 
Dereflection can be successfully used to help the family of the schizophrenic client. The purpose of this article is to provide a rationale for the use of dereflection with schizophrenic families and to outline the way one clinical practitioner has utilized dereflection with his clients. To appreciate the appropriateness of using dereflection with the schizophrenic's family, it is helpful to summarize some of the recent findings about the nature of schizophrenia and the types of family interaction often associated with schizophrenia. 
The schizophrenic client has a core psychological deficit which results in an increased vulnerability to external stress and particularly to external emotional stress. 1 This increased vulnerability may result in part from a biological-chemical disturbance within the receptor sites of the central nervous system.' Family interaction of the schizophrenic client is often overly emotional, stressful, and chaotic. 2 3 It has not been determined that 
• 
dysfunctional family interaction creates schizophrenia or that schizophrenia creates dysfunctional family interaction.3 it has been determined that the two processes reciprocally influence each other. 
Two major forms of overemotional interaction in schizophrenic families tend to stimulate increased symptomatic behavior in the schizophrenic client: criticism and over-involvement. 1 Decreasing criticism and over involvement often improves prognosis for the schizophrenic client and may prevent hospitlization or rehospitalization. 
In this author's experience, overly emotional criticism is most often associated with the family's hyperintention to "cure" the schizophrenic of his or her symptoms. This hyperintention is generally unrealistic and leads to anger, frustration, and criticism among the non-schizophrenic family members. Emotional overinvolvement in the family of the schizophrenic is often the consequence of guilt which is, in turn, triggered by hyperreflection about the schizophrenic's problems or the family's possible role in the development of these problems. Both hyperintention to "cure" the schizophrenic and hyperreflection about the schizophrenic process and the family's possible role in this process result in an increased level of emotionality within the family. 3 This in turn is experienced as stress by the 
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schizophrenic because of his or her hypersensitivity to emotionality. As a result the schizophrenic family member will then increase his or her manifestation of symptoms. A vicious circle occurs. Derenection by the family members in their daily life can decrease family emotionality and help the schizophrenic decrease the manifestation of symptoms. The vicious circle can then be broken or at least slowed down. 
THREE WAYS OF DEREFLECTION 
The most practical method to decrease hyperreflection and hyperintention is to help clients direct attention to something else.• This author has found three methods of dereflection to be particularly useful in helping the families of the schizophrenic to think about subjects other than the schizophrenic: l) Teaching the family about the chemistry of schizophrenia; 2) challc11ging the family role as "psychotherapist;" and 3) helping the family develop nonschizophrenic-connected interests and activities. 
The first form of derefleclion provides the schizophrenic's family with some basic information about the chemical aspects of schizophrenia. For instance, the dopamine hypothesis' of chemical imbalances within the receptor sites of the central nervous system is explained in as clear and simple language as possible. Charts and diagrams are used to explain this theory of causation and the importance of chemotherapy in the treatment of many forms of schizophrenia. In addition, the family members are told that it is important to help the schizophrenic client stay involved with his or her psychiatrist. 
Teaching the family members about the chemical theory of schizophrenia is useful as a method of dereflection because it helps them decrease their feelings of guilt. Hearing that such chemical problems may well exist within the schizophrenic's central nervous system will often help the family members realize that it is not "all our fault." This type of information tends to dramatically cut down the family members' hyperreflection about the schizophrenic process and their possible role in this process. This dereflection reduces emotionality within the family and has positive benefits to the schizophrenic family member. 
Challenging the family role as "psychotherapist" is a second way to reduce hyperintention in the client's family. Overemotional criticism of the schizophrenic by other family members is often a result of their frustration caused by their unrealistic hyperintention to cure the schizophrenic. To decrease family emotionality it is important to help family members give up their role as "psychotherapist." In this method of dereflection, too, the therapist is directive and gives the family members precise guidelines as to 
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which family behaviors are helpful and which are less helpful. In general, the family members are encouraged to set up a few simple rules that the client must follow, and to tell him or her about these rules in a matter-offact way. The family members are also encouraged to discontinue highly emotional conversations with the schizophrenic and to avoid arguing about his or her hallucinations and delusions. Such guidelines are often helpful to the family members because it gives them a reason or an excuse to decrease their hyperintention to cure the sick family member. 
A third way of dereflection is by helping the family develop activites and interests not connected with the schizophrenia. The therapist guides the family toward enjoyment and meaning found in varied new outlets. Members identify their interests and begin to respond to their home situation in healthier ways. 
The Sherman family was referred for community mental health services after their 23-year-old son James was discharged from a state psychiatric hospital. The son's diagnosis was paranoid schizophrenia and he had experienced nine separate psychiatric hospitalizations between 1977 and 1980. The referring psychiatrist suggested that James' parents should be seen in family therapy because the psychiatrist suspected that "crazy family interaction" was a primary reason for James' constant need for rehospitalization. The psychiatrist felt that if the community mental health center could help Mr. and Mrs. Sherman provide a more stable environment for James, he might be able to decrease his need for psychiatric hospitalization in the future. 
In the initial family treatment session the parents vacillated between critically blaming James for "all our problems" and blaming themselves for "making our son crazy." I told the parents that in my opinion neither view was correct and suggested weekly counseling sessions in which they would obtian more accurate information about the nature of schizophrenia and how to help their son. 
In the first stage of the parents' treatment, I presented some basic information about the dopamine hypothesis of schizophrenia and told them that I believed a dopamine imbalance was the primary cause of their son's problems. The parents were also told that this dopamine imbalance most likely made their son highly vulnerable to any emotional stress. The parents were then able to make the connection between their son's constant need for rehospitalization and their own overly emotional guilt and glame. 
After developing this insight the parents were helped to become less emotional about their son's problems. I suggested that the first step in becoming less emotional was for them to spend less time reflecting upon their son's situation and attempting to "cure" him. The parents were asked to keep a chart to find out how much time they spent each week hyperreflecting about James and engaging in efforts to cure him. Keeping 
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this chart helped the parents realize the disproportionate amount of time and energy they had focused upon their son. I asked them to identify at least five "fun" acitivites that they could use to replace the time spent on hyperreflection and hyperintention. The parents were directly, actively, and consistently encouraged to "trade in" hyperintention and hyperreflection for "fun" activities. Both parents have reported that this treatment approach has helped them rediscover enjoyment in life. James has not required hospitalization since his parents started this treatment. 
JAMES E. LANTZ, Ph.D. is a clinical social worker at Harding Hospital in 
Worthington, Ohio and a consulting clinical instructor at the Family Therapy Institute in Cincinnati. 
REFERENCES 
I. Anderson, C., Hogarly, C. and Rt':'i,, D. "Family Treatment of Adult Schizophrenic Patients: A l',;·i:ho-Eduiational Approach." Schizophrenia Bulletin, 1980, 6, 490-505. 
2. Beels, C. "Far:uly and :i:icial Management of Schizophrenia." Schizophrenia Bulktin, 1975, I, 97-118. 
3. I antz, J. Familr and Marital Therapy: A Transactional Approach. New York, AppletonCentury-Crofts, l 978. 
4. 
Lukas, E. "New Ways for Derefleclion" The International Forum for Logotherapy, 1981, 4(1), 13-28. 

5. 
Snyder, S. Biological Aspects of Mental Disorders. New York, Oxford University Press, 1980. 


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The International Forum for 
LOGOTH E RAPY 
JOURNAl OF ';f ARCH FOR Mf ANIN(,