SOURCE_DOCUMENTS/journal_007_1.txt

Volume 7, Number 1 Spring/Summer 1984 
CONTENTS 
The Meaning Crisis in the First World and Hunger in the Third World Viktor E. Frankl .............................................. 5 
Logotherapy as an Answer to Burnout Reuven P. Bulka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 
Logophilosophy for Israeli's Retirees in the Helping Professions David Guttmann ..............................................18 
Responsibility and Meaning in Treatment of Schizophrenics James E. Lantz ...............................................26 
Logotherapy and the Book ofJoh Alan J. Atlas .................................................29 
Odysseus: His Myth and Meaning for Logotherapy Ruth Hahlas .................................................34 
Logoanalysis for Alcoholics Robert R. Hutzel! ............................................ .40 
Finding Meaning through Existential Guilt Philip J. Sternig ..............................................46 
A Progress Report on Three Patients Guido Kiirfgen ...............................................50 
Maurice and Mr. Sleep Jovita Riveros de Carbone .....................................55 
Book Reviews ..................................................57 
Human Dignity and Psychotherapy: Mergence Through 
Logotherapy 

Keynote Address read at the Fourth World Congres·s of Logotherapy, San Francisco. June 28, 1984 
Elisabeth Lukas 
Human dignity and psychotherapy have hcen separated from each other for a painfully long time. Through logotherapy human dignity has again found its way home in psychotherapy. Let me illustrate what a separation hetween the two means by referring to two cases of criminal offenses. 
The first case concerns an incident which took place in one of the puhlic swimming areas in Munich last summer. A young man. fully dre~sed and wearing street shoes, sauntered over to the sunning area surrounding the pools. and kicked a teenager lying on the grass right m the face as hard as he could. He did not know the boy. The boy suffered serious injuries. including a broken cheekbone for which he had to undergo immediate surgery. The cheekbone healed so badly that it later had to be broken again and re~et. For months he suffered from the pain resulting from this brutal attack. and he still hears scars from it. 
We wonder what could have motivated such a senseless and cruel act. The young man was questioned by the examining judge who made the attacker undergo a psychological examination. That is how this young man finally came to our counseling center. The explanation: He had had an argument with his girlfriend shortly before, and she had Jet him know that the friendship was not going to last much longer. Right at that moment he felt an intense rage hoiling up in him, which he knew he was going to have to let out somewhere. That"s all there was to it, he said. 
The second case comes from a report in the (ierman newspapers. A man had picked up a girl hitch-hiker and had tried to assault her sexually. But she resisted, and when the car stopped at a red light, she opened the car door to jump out. Her foot got caught in a loop of the seat belt and she fell out onto the street. Onlookers tried to help her but the driver slammed the door shut and stepped on the gas although the girl was still caught in the loop. She was dragged sever kilometers to her death. 
This crime, too, was as incomprehensible as it was senseless, and one wondered about the motive. and again one felt uneasy with the answer. The man explained that he had not "had" a woman for a long time, and that he therefore just had to get rid of that sexual feeling. When it didn't go as expected, he said, a great sense of fear welled up in him which drove him to speed away. He just forgot about the girl caught in the seat belt, he added. 
What do these two stories tell us when we analyze them psychologically? Here we have two men ruled by intense feelings, by their basic need driving toward satisfaction: aggression and libido. And both men are in no way inhibited about looking for, and forcibly gaining, satisfaction. 
A Psychology of the Wrongdoer 
Psychology textbooks tell us about those drives and needs that have to be discharged, abreacted. These are needs which supposedly should never be repressed because they would then cause neurotic disturbances! Our psychology textbooks tell us about the therapy goal of reducing the patients' inhibitions, those very inhibitions which could hinder them in gratifying their needs. The catch words of living out our feelings to the fullest, of asserting ourselves, of strengthening our ego ring in our ears. According to these theories, both of these men would just about be all right, but what about their victims? 
We have developed a psychology of the wrongdoer, a psychology of the motives of the wrongdoer. We have a psychology which reveals the motives to us, and also excuses them. But we have not developed a psychology of the victim, or on how to deal with undeserved suffering, not to mention its prevention. There is none, except logotherapy. 
The whole dilemma goes back to a mistake the forefathers of psychology made a long time ago. That mistake was the uncoupling of the spiritual dimension from the psychological dimension in their concept of the human being. It was at the same time the uncoupling ofhuman dignity from psychotherapy. The psychological human dimension was thoroughly investigated, examined, and analyzed. Out of this came the view that we are primarily regulated by unconscious psychodynamic mechanisms, and that our most important reason for living is the fulfillment of our needs. Our nature was lowered to the level of our feelings. 
It is not surprising, then, when a person changes the feeling of"rage" into the act of kicking someone. Or, when the feeling of "lust" is degenerated into indiscriminate sexual molestation. Or when the feeling of "anxiety" misleads someone into the most irresponsible kind of panic reaction. After all, we have to do something with our feelings. 
Yet, what about a necessity in learning to control our feelings, keep them in check, some kind of self-discipline? Today we are willing to admit that while feelings are all right, we should not allow them to dominate us. Ultimately something is going to have to control our feelings without us having to repress them. Something has to watch over and guide our emotions, to impose ethical limits upon these basic drives. And that is out spiritual nature. 
We are faced today with the difficult task of reintegrating the spiritual dimension in our psychological concept of the human being. And we also have to make sure that the spiritual dimension gets that superior value which it deserves and must have if our human society is to continue. As difficult as this task may be, it would certainly be an enrichment for psychotherapy. Psychotherapy has its foundation in the concept of human nature prevailing at the time. But psychotherapy is in many ways unfortunately still based on a psychology "devoid of spirit" and running the risk of degenerating into a mechanical treatment "devoid of dignity." An example will illustrate this difference: a comparison between how one and the same problem was treated in a traditional group therapy, and how it was treated in a logotherapy individual session. 
The problem in this case was a patient's anger at her father who, according to her, had treated her badly as a child. This problem of "hating the father'' is not unusual for psychotherapists in Germany because many of the older generation of parents had considered it normal and appropriate to use bodily punishment in raising their children. And fathers have often been the parent who "wielded the heavy hand" on the children. What happened in the traditional group therapy was told to me by a woman who was herself present in the session. 
Two Approaches 
After the patient began to talk critically and reproachfully about her father, the therapist explained to her that the extensive repression of her feelings for many years was the cause of her psychological problems, and that she would be able to get rid ofthem only by reactivating her inner anger before the group. The therapist then rolled up a blanket into the shape of a person and laid it down on the couch as a symbolic substitute for the father. 
Let me contrast the above report with what I once advised a middle-aged woman to do. She had come to talk to me and mentioned the anger she had felt for her father her whole life. As I am a logotherapist I never look at the person solely in terms of her feelings. Rather, I always include the spiritual aspects of her existence in my considerations. Therefore I saw the problem from a different perspective than the above-mentioned group therapist. I am not disputing that hatred of a parent can poison a person. But the reason this happens is not, in my opinion, because a repressed feeling is permanently striving for discharge; rather that one simply does not live well with hate in one's heart. One dies even less well with such hatred. Hate is contrary to the spiritual striving for meaning because this striving seeks reconciliation and can never be "worked through" except through a forgiving love. 
So I asked the client whether she had ever thought of a reconciliation. But she replied sadly that it was impossible for her even to carry on a serious conversation with her father. Whenever she went to visit him, he was almost always sitting in front of the television set. And when she broached the subject of what had happened in the past or what had come between them, he would impatiently tell her to be quiet so he would not miss the show. But even after the show there was always something which came up to prevent a real talk between the two. So she had given up on her father a long time ago. What I told the woman was this. I said: "Your father is old, and he is not going to change any more. The only thing that can cange is your attitude about him. So the issue here is not really a dialogue between you and your father, especially since it would hardly be productive. Rather, it is a matter of a dialogue within yourself~ a dialogue between your feelings and your conscience. Your feelings reject your father. and maybe that is justified. But your conscience pleads for forgiveness. because it also is dependent on being forgiven by other people when you make your own mistakes. Up to now your feelings have dominated you. How would it be if you 
let your conscience suddenly get the upper hand'.". 
"'Yes. that is what l want to do."the woman ,ohbed. "but tww do Ido it'r"'ll\ \Cry simple." I said. "When you go to see your Lither again. and heh sitting in front of the television.just go right over to him and give him a kiss 011 the cheek without saying a word. Regardless of what he says or does. that ki~s can he a symbol of the reconciliation of your feelings with your conscience.;\ sign d forgiveness Wward an old man. Through this gc•;ture You relieve your father of his guilt, and at the same time you relieve yourself of your hate." The woman foilowed my advice. and she not only found her inner peace. She was also ~urprised hy the reaction of her father who.. she told me on the phone. also \\ithout saying a word took his grown daughter in hi, arms and embraced her. 
I confe\s that l used to he more timid ahout asking people to rdim1uish various things than! :.1m tod;iy l have found the eour(1gt· to a,k my patients to ,acnfice something \vhen it is ncees~ary, hut only srncc l h:1\e understood tv.u thing,. First l have understood that. from the: pomt of vicw nf our spiritual dimension. it:, always a matter of values rather than of.1atis/i1ctio11. Secondly. I have understood that valm:s are often concerned with se:ting a~ide one\ wishes. whereas ~atisfaction always has to do with satisfving a wish. Viktor Frankl made this remarkable statement 1n his hook 1/omo paliens: 
What l keep does not keep its value. But what I give gains value. 
Resistance to Sacrifice 
In the same context he talks ahout "giving meaning" (Sinn gehcn) as a form of ·'sacrificing something" (preisgehen). which mu~t he done for the sake of the meaning to be actualized. Nevertheless. it is extremely difficult for a person spoiled hy the affluence of the present Western culture to make a sacrifice, even when it would be meaningful and the value gained would be great. Modern people just cannot ~tand any pain at all, which is good for psychotherapists: people come running at the slightest problem. But actually this endangers the society as a ~hole. because a single real catastrophe would suffice to start the breakdown of society. !hi~ reminds me of an observation 
of my dentist who told me that forty years ago he could pull teeth without 
administering any anesthesia. Thirty years ago he only brushed the gum 
arond the tooth with the mildest anesthetic. Twenty years ago he injected 
local anesthesia when pulling a tooth. For the last ten years he has been 
injecting very strong anesthesia and. he says, people today say '"ow" as soon as 
they hear him testing the drill in the air. He said he has not yet found an 
effective treatment for this last problem. 
We logotherapists are not for self-castigation and against enjoying life. On 
the contrary, we consider senseless distress just a~ pathological as the sense
less suppression ofthe joy of life. Whenever pain can he reduced. it should he 
done. And whenever suffering can be avoided, this has priority over all else. 
But the concept of"sacrifice" is always related to a "what for," which a lone determines the meaningfulness of every sacrifice. The grea/er the value ofa "what for," the greater the meaning ofthe sacrifice to he made. In addition. 
everyday psychology teaches us that there is a reciprocal relatiomhip between the short-term and long-term aspects of personal gains and losses. Doing without something for a short time -we could also speak of "sacrificing"' -often makes possible long-term gains in value, which could not otherwise be reached. For example, the long-term goal of the deep satisfaction ofhaving raised a child who is happy and capable demands a great many short-term sacrifices made over the years for the sake of the wellbeing of the child. Similarly, the long-term and proud completion ofan education demands that one relinquishes short-term wants for years for the sake of continually studying and learning. And conversely it can also be shown that the constant search for short-term advantages and gratifications often makes long-term gains impossible, and even gives rise to long-term unsolvable problems. Parents who neglect their children again and again, in order to find short-term pleasures for themselves, get themselves into trouble in the long run with their children, causing for themselves a great deal ofgrief and sadness later on. The same thing is true for young people who interrupt their education for the sake ofshort-term excitement. They will later be punished by unemployment or an undesirable job. 
For many patients in psychotherapy, their willingness to forego some things for a short time will decide whether they will improve or not. Alcoholics cannot be helped if they are not willing to make a short-term sacrifice and do without that next glass. And compulsive neurotics are completely at the mercy of their compulsions if they are not able to stop that short-lasting but insidious avoidance behavior which only makes their anxiety worse. 
It is therefore not at all an erroneous therapy goal to strengthen a person's ability to do without, so long as this is still meaningful. In any case, this is a goal with more human dignity than that of a psychology devoid of spirit, which emphasizes having to abreact and to act out, and which has already done much damage. 
When the therapy goal includes sacrifice, the threshold ofspiritualfreedom has already been surpassed. The old psychological determinism was overcome at the very moment when the concept of sacrifice found its way into psychology, and this happened with logotherapy. A sacrifce presupposes not only a what for, but also free will. The freedom to choose: We can also choose not to sacrifice. Wherever this is not the case, wherever people are under compulsion and really have only one choice of responding (which means they do not really have any choice at all) we cannot speak of sacrifice. We can speak of an urge, of suffering, but not of that inner relinquishing which is done for the sake of a meaning. 
Thus, sacrifice presupposes freedom. But the reverse is also true. It is a fact that people do make sacrifices, and on a completely voluntary basis, for a cause or for some other person who is worthy of this sacrifice. And this fact proves that the will is free and that we human beings are not the slaves of our feelings or the stooges of a system of hydraulic drives. This talk of having to react and this excuse of having to abreact have shown themselves to be untenable. The same goes for the many theories which deal with the analyzability of our psychological dimension and which are alleged to have grasped the very soul of humankind. 
Freedom and Fate 
For thousands of years we hive been aware of the many aspects ,if our existence, and for just as long we have speculated about that mystery called the soul. The greatest philosophers were unable to solve rhc "body-soul problem." They could only describe it, and their most frequtnt distinctions were that the body is visible and the soul in~isihle, and that the body is material and the soui immaterial. 1 he various religium added that the body 1s mortal, the soul is immortal. At the beginning of the twentieth century when psychology deveioped into a social science, 1t simply uansfor med the concept of son! into a psychological concept which was the base of all emotions and the reservoir of all learning experiences. In this way it became the foundation ofall our vital impulses Adistorted picture arose, ofa completely determined homunculus ruled like a puppet by childhood exper:ences and inner drivc5. 
Frankl was the first to correct this inadequate transformation of the soul into something emotional. He complemented the p,ychoiogical concept with freedom of the will and human dignity.. that is to say, by integrating the human spirit. In this way the old distinction between body and soul, which had hinged more or less on concretion and abstraction, gave way to a new distinguishing criterion, the criterion offreedom and/aw 
BODY i old dis=] 
visiUe, tine.lion 
m,xl:erial (c.oncte~ion) 
SOUL 
-1, 
invisihle, 
immaterial 
(abshachoh) 

Perhaps another example from clinical experience can illustrate the kind of revolution which this new distinguishing criterion brings about for psychotherapy. A few months ago a physician at the Munich Dermatological Clinic consulted me about a twenty-year old female patient whose skin was chronically broken out, looked ugly, and disfigured her face. 
The young woman kept on repeating the sentence: "I am repulsive." The physician was afraid that the worst might happen, especially since the woman had no family where she could get some consolation. Because she felt so repulsive, she was also negligent in applying her medicine. There was no hope or improvement if she did not apply the medicine on a regular basis. One psychologist had tried to trace the young woman's feeling of repulsion hack to "playing doctor"when she was a child. A young boy in the neighborhood had once shown her his penis. But the patient indignantly rejected this interpretation, and in any case it had not had any positive effect on her. 
From the very beginning the question for me was not where the repulsion came from. Something ugly can be repulsive to a sensitive person, and her skin was really anything but nice. For me the question was rather how a twenty-year old woman was able to live with such a fate, and what strength she might have to resist it. Now we come to the concept of "fate." What exactly was fate in all of this? Was there any leeway, any area of freedom, within which the patient could make her own decision? 
Her bodily dimension was burdened by her disease, and this disease was her fate. Her emotional, psychological dimension, was burdened with her feeling of repulsion, and this repulsion was fate. But her spiritual dimension was completely unencumbered; it was called upon to take a position on her disease and repulsion. The young woman as fully able to adopt any attitude, have any opinion she wanted. There was nothing in the world which could force her to any particular spiritual attitude. Here we found some room for change, an area of freedom. We had to show her this room into which she could move, this area offreedom. The first thing she learned was that her statement, "I am repulsive,"was false. It was false because there was a spiritual ego in her which in no way deserved repulsion. The statement had to be rephrased: "My broken-out skin is repulsive." and this she was able to accept. 
The second thing she learned was to take her broken-out skin and her repulsion together as a psychophysical challenge of fate to her. A sentence by Viktor Frankl helped her meet this challenge, a sentence which I often quote to those looking for advice when they have to have a dialog with their own fears and weaknesses. It goes like this: 
There is something you cannot take from me: my freedom to choose how I respond to what you do to me! 
Whenever the patient was overcome with feelings of hopelessness, feelings of 
hating herself and of being repulsive, she answered them with the words 1 
quoted, and right there her negative feelings lost their power over her. 
The last thing left to do was to strengthen her will to become healthy. 
Whether the will can be taught or trained is an old controversial question. It cannot be adequately answered unles the spiritual or -in logotherapy terms -noetic aspects of human existence are distinguished from the subnoetic aspects. At the subnoetic level it is entirely possible to prepare the way for the will, as we know from educational theory or from work with the mentally retarded or those addicted to drugs. On the other hand, it is neither possible nor necessary to train one's willpower at the noetic level. Here we can confidently trust in our will, if we only know what we want. The wiil is one of those phenomena which in themselves are not things to be wanted. But when something else is wanted, one has as much willpower as one needs. For this reason the patient could not be made to want to become well. But we hoth peculated about what she could do meaningfully with her life. And here she just overflowed with future plans, which would be a reward for the dismal time spent in the clinic and for bravely going through the necessary treatment procedures. This was a future worthy of overcoming repulsion and strictly following the doctor's orders. That "what for" demanded a voluntary sacrifice, the sacrifice of overcoming the repulsion. The young woman finally assented to do this without any additional pressure from outside. From that day on her condition improved, as if her spiritual affirmation of wanting to get well had itself been binding for hoth body and psyche. 
The psychologist at the clinic, according to his training, asked why the patient necessarily had to feel repulsive, and he made a trauma in her childhood responsible for it. I, according to my training as a logotherapist, asked to what degree the patient was free to resist her repulsion, and I made her personally responsible for her behavior within the limits of her freedom. Her "having to" feel repulsive removed her guilt for her lack ofcooperation with the doctors, but it also made her into a person who was not yet able to decide for herself, a person who was at the mercy of her feelings. The "being free"to resist repulsion saddled her with responsibility and made her ready to sacrifice something, but it also made her into a person who could respond for herself. The lesson to be drawn from this example is this: 
Pointing out to a person that he or she still has a certain amount offreedom, even ifthat is all that is left, is more than a psychotherapeutic technique; it is also an act ofhuman dignity. 
Recoupling the Spiritual and Psychological Dimensions 
With this in mind let us go back to the recoupling of the spiritual and the psychological dimensions in the logotherapeutic concept of the human being, and consequently to the new distinguishing criterion of the age-old body-soulproblem. This problem is now seen as a dialectic of the psychophysical and the spiritual. We are unaccustomed to think in accordance with this new criterion, and it has had little influence on our usual way of seeing things. I notice this again and again in conversations with group participants and with students, when I have them write down everything they would ascribe to fate and then everything they would classify as human freedom. Under the concept of"fate" they list bodily determinants such as state of health, age or sex, accidents of a positive or a negative kind, hence good luck and bad luck, and social and environmental factors which the person does not have completely under control, such as war or peace, prosperity or unemployment, friendly or unfriendly relatives, and so on. Under the concept of "freedom" they mostly show how much leeway they have within the limits of their situation, their everyday activity or passivity. 
When I then ask them where they put feelings, they usually agree that feelings belong to fate, because we obviously do not freely choose the ones we have. It is also impossible to order someone to be joyful or to be angry for the next five minutes. This proves that feelings are conscious or unconscious automatic side-effects of the events causing them, and those events are not immediately subject to the will. Thus, feelings just come up as part of the circumstances of fate. This does not mean that there are no reasons for them or that we do not have a part in causing them. Rather it means that at the time when a certain feeling comes up, there was no free inner choice about whether that feeling should come up or not. 
Then I ask further: Where do you place the attitudes? Are attitudes determined beforehand by models, experiences, or other influences? My students usually give a negative answer. Of course, attitudes can simply be taken over from the past or from the social environment, but they do not have to he taken over. There is still the personal choice to be made; it is still a decision of our conscience. Even when we are easily influenced by the opinions of others, we still have the choice of how we stand toward outside influences. Therefore, attitudes are free. 
I then pose another question which at first seems easy to answer: which do you like better -the fateful aspect of human life, or the area of freedom we have? Most students immediately say: The freedom, ofcourse, because we have a say, we can help decide, take our lives in our own hands, and guide ourselves wherever we want to go. Yes, that is true. People have always been magnetically attracted by freedom. It has been their dream since Adam and Eve. 
Yet there is one thing which balances out the negative side of fate with a positive, whereas this same thing is inherent in human freedom and cannot be put aside. And that is the aspect of responsihility. Fate entails that the circumstances themselves cannot be changes. But we are not responsible for what we cannot change and have not chosen, nor can we be at fault in such circumstances. However, what we have chosen freely, done freely, decided freely to be a part of our own lives, to this we have committed ourselves with all its consequences. It is undeniably our own deed or our own fault. When we look at it this way, we may hesitate to prefer the area of freedom. For freedom may well be a gift, but it is also a sentence to responsibility. And fate may well force us to do something, but it is also a pardon from responsibility. 
FATE (defined as that over which we do not have a choice at that time) 
Examples 
Social and environmental factors Positive and negative 
accidents Bodily factors Emotional factors 
(Feelings) 
NO RESPONSIBILITY 
FREEDOM (defined as that which we are free to decide at the particular time) 
Examples 
Our own arrangement of our environment Conscious reactions to 
accidents Voluntary behaviors Taking a stand 
(Attitudes) 
RESPONSIBILITY 
Thus, the recoupling of the spiritual and the psychological dimensions by logotherapy has had several consequences. One of them is that we are no longer the puppetlike homunculi ofan outmoded psychology because now the area of freedom, which everyone has regardless ofthe situation, is taken into consideration. Another consequence is that the distorted relationship between ethics and psychology has been corrected because the consideration of one's personal freedom necessarily entails a consideration of one's own personal responsibility. 
Here the reintroduction of human dignity into psychotherapy becomes obvious. If you take responsibility away from people, you also take away their dignity, as Frankl says. A form of psychotherapy which excuses people is also a form of psychotherapy which degrades them: our being sentenced to freedom is a prerequisite to our becoming guilty. 
On the other hand, there is also the pardon, the exemption from responsibility, which is part and parcel of fate. In view ofthis it is the task of psychotherapy to resolve the patients' unjustified feelings of guilt in order to restore their sense of dignity. An example: A man came for therapy who was ashamed to even tell me what his problem was. He felt strongly attracted by children about whom he had sexual fantasies. This happened especially at the meadows along the lsar River in Munich where, during summer. many children run around in the nude. He was afraid he might give in to this urge and assault some child. This bothered him so much that he did not go to the river at all and even avoided all places where he might suddenly be alone with children playing. But the fact was that nothing had ever really happened. That man had absolute control over himself, but he felt guilty because of his abnormal thoughts and fantasies. 
This is the issue where I intervened and relieved him of every shred of guilt. 
Feelings and compulsive thoughts belong to the circumstances offate. They are not freely chosen but suddenly come up, wherever they may ha\'e come from. The man was in no way guilty for having these pedophile tendencies or for having the anxious hyperreflections associated with them. What he alone was responsible for, was within the area of his freedom -that of deciding between giving in to his tendencies and resisting them. 
Within his area of freedom, however, he had always chosen to resist. Thus he behaved with responsibility, and that is certainly the kind of behavior which we can recognize as praiseworthy. I was therefore a hie to tell him: "You do not have any reason to be ashamed. On the contrary, you should he proud of yourself. You are in fact a respectable man, and your tendency to have sexual fantasies does not alter that fact. The only question now is how you can manage your emotional turmoil better, and there arc psychotherapeutic methods which can help you." I thought about a combination of paradoxical intention and dereflection, but surprisingly these turned out to be unnecessary. My explanation that he was basically respectable and that he was free of all guilt, had such a positive effect on him that he felt relieved of the problem and gradually overcame it completely. He even went to the meadows along the Isar River again, and later he told me that at the sight of children playing he only had a deeply satisfying feeling of his acceptance of himself. 
How different is this behavior from that of the young man I mentioned at the beginning, whose unspeakably brutal behavior took place on the pretext of having to abreact his feelings! That man was not tormented by feelings of guilt after he had kicked an innocent victim in the face. But he should have felt guilt because in spite of all that went on before his assault, he was still fully able to think and was consequently free to choose how he responded. He wantonly chose a negative behavior. If any form of psychotherapy can reach him, it would be one which could show him these connectons. 
It is not the intention of logotherapy to put blame onto patients, nor is it interested in exonerating them ofguilt. Logotherapy is concerned rather with insight into just how far we are free and hence responsible, and how far we are the plaything of our fate and hence are not responsible or guilty. Which variant may be more to our liking is an open question. What would you prefer: being run down by a car while walking unsuspectingly on the sidewalk, or being the driver of the car who, in a moment when you paid no attention, runs down an innocent pedestrian? 
If you are the victim, you have the pain hut at least you do not have any guilt. The car from behind was your fate. On the other hand, if you are the negligent driver, you do not suffer any physical pain, hut you do have a suffering of a different kind. Your failure occurred within your area of freedom. It is a difficult choice. It reminds me ofthe saying, "the mother ofthe murdered son can sleep, but not the mother of the murderer." 
These considerations have applications in therapy. Some of my patients pay attention mainly to the circumstances of fate, and others primarily to the area oftheir freedom. Some depressed people are in sheer despair ahout their depression. And others think about what they can do about it in spite of feeling depressed. The former perceive their fate, the latter perceive that amount of freedom which their fate just barely allows. Some people constantly live in a past filled wi1h sorrowful memorie~ from which spring the complaints of the present. And others use the sorrowful memories of their past. to renew and transform their present. The former use up their energy in coming to terms with fate because the past, in its immutabilty, belongs to the circumstances offate. But the latter increase their energy in grappling with the circumstances offate --energy which they can use to shape their present area of freedom. 
Within the area of fate, there is not a single possibility available to us because by definition we do not have any choice within that area. But in the area offreedom there are as many possibilities as there are star~ in the sky, and for every single situation and every single moment we can pick one or another. But when we have chosen, we have oblitcrntect all other possibilities of that same situation, and they'll never return again. Certainly there will be new situations with new possibilities as long as we live, but the starry sky of a particular moment passes away when we make just a single ~tar our concrete choice. 
PERSONAL AREA OF FATE 
AREA OF FREEDOM 
0~
X 
'\ X'
" 
)( 
X if one possibili ly is chor.en,l( x all of lhe oE'1er X X pos,;;b;L;lies of 
X 
this si !udtion 
em p t y 
X ar-e obl;lera!ed )( :x {or ever. 
X 
>< )( X X 
\ I
v The entire "slarry sk,/ of possi bili lies per situ orfion 
For example, when you got up this morning, you had numerous possibilities as to how to spend the morning. but after you decided to attend the Fourth World Congress of Logotherapy, ali other possibilities of spending this morning were lost. Never again, not in a million years. will you have this very situation of choice. But your choice of having visited the Congress can never be undone. The morning ofthis Congress is from now on an inexchangcable component of your life. Of course, if after getting up this morning you had lost consciousness, your area offreedom \Vould have been closed and fate would have determined what would happen to you. Perhaps someone would have taken you to the hospital, perhaps you would have just stayed lying wherever you were. In any case, your own personal possible choices would have been zero. Thus, the area of fate and the personal area of freedom are often mixed together (just as the diagnostic systems for psychological disturbances really are!). But for that very reason it is important to distinguish the two areas from each other and to concentrate on the area offreedom which is available to us. Patients who do this have a higjump on those who do not do it. Those who look at the circumstances offate are looking at emptiness. !'hey live in a world which is cemented shut and in which there is nothing to remove and nothing to change. On the other hand, those who look at their area of freedom, however small it may be, see the many possibilities of the situation, and among those the many meaningfulpossihilit ies. As you all know, Frankl has called the conscience our "sense-organ" which is always able to intuit the hidden or obscured but "ever present" meaning of a simation. On the basis of our drawing we can also call the conscience the organ to help us find the brightest star in the starry sky ofthe moment. Which means finding the most meaningful choice out of all the possibilities present in that area of freedom. 
The real advantage for those people who primarily perceive their area of freedom is that they have the chance to feel satisfied. For when we can say that we have done everything possible within our area of freedom, especially what has been "meaningfully possible," then for us this is good. Then we can be satisfied with ourselves, regardless ofwhat our fate may now seem to be. The feeling "it is good" is in the last analysis the awareness that "I have done everything that is possible and meaningful." This awareness we do not get if we keep our eyes on the circumstances of fate. because fate will always provide us with a reason to be dissatisfied with something or other. 
The Five Bears 
To help my patients, in spite oftheir own personal limits and needs, to push forward to this experience of "it is good," I developed in my last group five humorous picture cards which I gave the participants to take home with them. It was a post-therapy group, most participants had long periods of illness behind them. Two women had been diagnosed as incurable before I saw them. Prior to joining the group all participants had received individual therapy from me and had become relatively stable again but they were still faced with the shambles of their life which their illness had left. 
We talked about the ideas I have just discussed, and the patients expressed the wish ofhaving something in writing which would remind them. in times of crises, to focus on the present possible meanings of their lives. The idea came to me to adapt for adults five picture cards which were used effectively in a thrrapeutic program for children. They represent five stages of an ideal response pattern for actual life situations which can bring ahout a constructive rethinking of a situation. 
What is my problem? 

\./hcd: is my problem? 
Which pos,ible choices do I have? 
\./here is my arec.t of fteedom? 
One of lhese is lhe most meaningful! 
I want ~o ctch.1alite 
thls one! 
The first card asks: "What is my problem'!" This is not a uniquely iogotherapeutic question, but rather is the psychological 4uesuon asked hy everyone v. ho in some way does not feel good. It concerns our psychol<1gi,:;d dimension because a problem is in reality always an emotional prL1blem caused hy sadness, fear, anger, desire, disappointment, or whatever. lt is the crnnti1'n as,nciated with the actual situation. and not the situation as such, which causes the problem. For example, if you have been di\orced afld think: "Grrat' I am rid of my partner,"then the divorce is not a problem. It becomes ,1 problem when you regret losing the other person, or when you cannot stand the loneliness. or when you now hate the other person. Similarly, when you lose your job and think: "I can finally have a rest!", then unemployment is not a problem. lt becomes a problem when you get feelings of inferiority, fear of the futme, and ~o on. 
Our first bear is standing in front ofa stop sign. That i~ the emotional barrier which holds him on his path through life, but the problem is that he is not yet clear about this. After he has become clear about that, the hear on the second card turns into a new and logotherapeutic direction: in addition to the psychological dimension he lets the spiritual dimension come through. This spiritual dimension goes beyond all stop signs and barriers and allows a certain area of freedom within one's inner attitude toward the problem, toward the emotions, and toward the given situation. 
"Where is my area of freedom?" Patients who look for their freedom will find it. And when they find it, they have the entire starry sky of possibilities spread out in front of them. The bear on the third card is asking himself about these possibilities. Emotion is no longer determining the issue. Here cognition has its say, and cognition has a wealth of ideas, releasing our whole creativity. When we explore our possible choices, we will find many more than we suspected, even in difficult life situations. 
But knowing the various possible choices is not enough. Our spiritual dimension must raise its voice, the voice of our conscience as the human "scnseorgan," which senses meaning. It would be easy for emotion or even cognition to make the wrong decision, a decision against meaningfulness. This would occur ifthe emotions were chosen according to the principle of blindly "wanting to act out," or if the cognitions were chosen according to the principle of the greatest possible advantage for ourselves. the principle of blindly calculating without reference to values. The conscience, however, is self-transcending. It allows us to rise above ourselves and see the world in which we live. and to see the "one right thing to do" right nqw and here. Only our conscience can sense which one is the most meaningful choice of all the possible choices in the situation. After we know that, there is only one more choice: to follow our conscience or not. The bear on the fifth card is speaking for following our conscience, with the intention of actualizing what we know. 
You may be wondering whether the original problem has thus been solved. I would like to say this: It is certainly not the same prohlem it was at the beginning. Patients who have inwardly followed the path of the bears, have left the stop sign behind them. They may still he suffering emotionally \nmcwhaL but they know where they ought to go and their pathway is open. 
I gave these cards to my patients also because I wamed to bring some humor into our serious discussions. Logotherapy appeals, and with good therapeutic reason, to people's sense of humor. The patients used the cards in various ways. Some put them up on the shdfabove the fireplace and looked at them every day. Others took them out of the drawer only when they were bothered by a problem. One woman gave them as a gift to her daughter. who went through stressful schooi tests. With the help of the bears she succeeded in keeping calm and getting one requirement finished right after the other. Since the group sessions have ended, every patient without an exception has told me at some time his or her own personal "bear story" ---how they were able to help themselves in critical situations by referring to the questions on the cards. 
l should like to read to you one of the most beautiful of these "bear stories'' and by doing so return to our theme of human dignity in psychotherapy. The story, which I tell with the patient's permission, is a touching documentation of "humanity" which we psychotherapists can only regard with respect and admiration. 
She wrote: 
"I have suffered from a series of symptoms. When one disappeared, the next one came. You, Dr. Lukas, were the ninth therapist who tried to help me. I have often spoken of how sad my past life had been. I have been given interpretations for my conditions and diagnoses have been produced. I was narcissistic, infantile, my child-ego dominated me. Then you worked with me differently. You taught me to take my symptoms less seriously. You helped me to have courage and self-confidence. With you I have become much more relaxed. But there is something I have never talked about. Not with a therapist, not even with you. I don't know why myself. It is something that has never given me any peace, as long as I can think. I get too little love. People don't love me. No one loves me as much as I want, and need. Love! Why has love been closed off to me, oh God, just why? I have never told this to anybody, but it is the only thing that really hurts me. Everything else is almost just an afterthought. No, that's not so. Or is it? After having had so much therapy I should finally understand myself, but I have become even more unknown to myself. 
Then the other day I took out the bear cards again. I was alone at home, and it was nighttime. I cried about the first card. Then I looked at the second card. My area of freedom ... I couldn't think ofanything. But there must be something! Then I had the thought: what am I waiting for? If I can't have love, then I can he love. Be love ... The thought seemed strange. And entirely new. How is it when love is inside a person, when love radiates from me? Once you said something about having and being. Having, you said, is something you can lose, but being cannot be lost, even when it is past being. I looked at the third card, and now I knew what you meant by the "starry sky of possibilities.'' All at once I had an incredible number of ideas. All those people I see every day, I could be friendly to them, much nicer than before. They could feel love in my presence. ls that really possible? Permeated through and through with love --what an idea! Then I made plans and pictured it all. How I would go right up to people without hesitating, how I would invite my friends over, and how everyone would thank me for the evening. But the fourth card made me serious. My conscience was really tough on me. "You are filling yourself full of illusions," it told me. "It is not meaningful to try to buy affection. If you want to love, then you have to take people as they are. Without expecting something in return. For example, the old woman on the fourth floor who is always so rejecting. Give her some flowers and just swallow her unfriendliness. then you can love!" Whether you believe it or not, that's what my conscience said. 
The next morning I went to the florist and bought a bouquet of spring flowers. I took it upstairs to the old lady. She did not say a word,just looked at the flowers and looked at me. Then I felt, from now on things will be different. I am not going to complain any more that I get too little love. That is not the issue at all, getting is not the issue. There was just too little love in me, and that I can change. I change it a little bit every day. I take the fifth card with me in my handbag, wherever I go. Some day or other I am just happy. It is not the happiness I dreamed about, but it is a good happiness. Yes, finally it is good." 
This woman's letter woke me up to an idea which might be generally true. It might lead to a breathtaking theory if we were to follow it out. Let us assume that there really are people who intensely concentrate on the causes oftheir fate. And that, on the other hand, there are people who are quicker to see their area of freedom. Wouldn't that mean that the former also more frequently talk about the causes oftheir fate, because we talk about whatever we are concerned with? Now, depending on whether the patients are oriented more toward the circumstances of fate or toward their area of freedom, wouldn't that determine how much they talk in our sessions about such things as environmental influences, mistakes by parents, or their illnesses or accidents, which then provide the basis of our psychological interventions with them? This would mean that two patients with a similar background might tell two different stories. One of them might tell the interviewer how he had been ignored by his mother too much, or how he was shocked when his dog was run over by a car. In other words, he would emphasize the degree to which he was at the mercy ofhis circumstances. On the other hand, the second patient might bring up that her mother let her decide on her profession, or that she had always liked animals -in other words, that she was able to participate in deciding what would happen. For three quarters ofa century psychology has taken at face value what patients have said about the events in their lives, has reconstructed their life histories on the basis of what was said, and consequently has drawn conclusions about the patient's current state. But couldn't the truth be rather that both the selection of the reported life events as well as the description of how the patient is currently doing, represent simply and solely the degree to which the persons attention is 
focused on the circumstances offate? That they signify the extent to which the patients do not feel free, although there actually were areas offreedom for them? Is emotional illness, or let us say it more carefully, neurotic illness nothing but a dead-end street of the mind, a chronic concentration on what is unchangeable or, as the case may be, an inattention to what is changeable? 
If that were so, we could solve the contradiction between the assertion of innumerable psychology textbooks, that neurosis results from early childhood frustrations, privations, and inadequate parental models, and the fact that millions of people all around the world have had a bad or difficult childhood and still have matured into completely normal adults. It is obvious that those who do not make responsible use of their freedom, because they are not even aware of it, will fail in their grown-up life, just as they will fail when they try to look back only upon the facts oftheir past. They overlook the chances they have in their present life, and the chances which their childhood concealed. They only notice what the environment inflicted on them because they have not identified themselves as persons who themselves respond to "inflictions of all kinds" and freely respond according to their own choices, as the persons who in spite of everything they truly are. 
Human dignity is something that every person has, the poorest, the sickest, the most useless person. Psychotherapy is something which we should be able to apply to the poorest, the sickest, the mot useless person. Ifwe want to merge the two, we will have to operate within the area of our last "possession" which absolutely cannot be taken from us except by death, also by mental death. And this possession is our 5piritualfreedom. Logotherapy is the only therapy which has succeeded in fully integrating spiritual freedom in its medical and psychological concept of the human being. This is why logotherapy deserves to be called a psychotherapy worthy of human dignity. 
ELISA BETH LUKAS is director ofa counseling center in Munich, Germany. and teaches logotherapy at the University of Munich and at the University of Innshruck, Austria. She is the author offive books on logotherapy in German, one of which (Meaningful Living) is available in English from the Institute of Logo therapy. 
YOU ARE INVITED TO ATTEND, AND SUBMIT PAPERS AND PROPOSALS TO 
THE NORTH AMERICAN REGIONAL CONFERENCE 
(Canada, United States, and Mexico) 
THEME: Logotherapy and Life -Purpose and Meaning in Transitional Times 
DATES AND PLACE: June 20, 21, and 22, 1985 in Kansas City, MO 
SPONSORED BY: The Kansas City Chapter of Logotherapy in conjunction with the University of Missouri 
CALL FOR PAPERS: I. Formal papers on logotherapy, logophilosophy, and logoeducation (up to 20 pages, 3 copies, 150-word abstract, author's biographical page) 
2. Proposals for workshops, panels, or symposia (two-page outline, identifying title, purpose and goals, intended audience, names and information of all participants) 
DEADLINE FOR PROPOSALS: January 25, 1985 
SEND PAPERS, PROPOSALS, AND INQUIRIES TO: James D. Yoder, Ph.D., Kansas City Chapter, Institute of Logotherapy, 1041 Holmes Road, Kansas City, MO 64131, Tel. (816) 941-0880. 
Logotherapeutic Support Groups for Cardiac Patients 
Edward Lazar 

lnvestigations3 revealed that for many cardiac patients much more can be done about rehabilitation than actually is. Those responsible for returning the survivor of a myocardial infarction, or cardiac surgery, to as near a "normal" life as possible, need to adopt a philosophy of treating the three-dimensional total person. Non physical, as well as physical, aspects of the illness need to be considered, for example: anxiety, anger, fear, and guilt. Behavioral and attitudinal changes ought to be emphasized more than they are, because lifestyle plays a major role in contributing to the prevention as well as to the pathogenesis, onset, development, and complications of heart disease. Every effort should be made to restore the individual to a healthy body, psyche, and spirit. 
To augment the physician and family, and for that support which might be lacking, the patient should be encouraged to participate in a support group. The support group is another tool which can help the convalescing cardiac patient overcome some of the problems already indicated. Group participation, whenever feasible, should be suggested by the physician and implemented at the time of discharge from the hospital, or as soon as possible thereafter. 
I prefer support groups of 12 or fewer persons, thus allowing time to focus on each member's problem-of-the-moment. The participants meet in an informal, intimate setting to discuss, learn, and consider how cardiac patients might adjust in order to improve their quality of life. The group meets regularly, bi-weekly, for approximately one and one-half hours each session. The aims of the group are therapeutic: to emphasize the participants' responsibility for their own welfare; to enhance awareness, sensitivity, and self-esteem; and to make them feel at ease with their own emotions and those of the people around. 
The techniques which I use to help each patient striving to achieve these goals are, for the most part, logotherapeutic in nature -the Socratic dialogue and dereflection. '·2 Through the Socratic dialogue and by directing the participants to focus attention on helping other members of the group they usually gain insight into the necessity to clarify their own values, and to change attitudes and lifestyle. The following mental sets are used as the basic guidelines for a healthful emotional lifestyle: 
1. 
The world I live in is the world I perceive. There is no outside emotional stress, there is only my subjective response to a situation, which I will learn to control. 

2. 
I will do one thing at a time. 

3. 
I will do the best I can about a situation, and then I will not worry about it. 

4. 
I will express my feelings honestly to others. 

5. 
I will find meaning in my life. I will think and live positively. 

6. 
I will treat all others, including children, with the respect I wish for myself. 

7. 
If I should be dissatisfied with a relationship, I will take steps to improve it. 

8. 
Death is a normal, inevitable part of human life; I will face this fact and accept what I cannot change. 

9. 
I will be aware of my own needs, rather than those inspired by competition. 

10. 
I will realize that there are always options; that I have freedom of choice. 

11. 
By keeping in touch with my body and its needs, I will choose to be well and happy. 

12. 
I will live in the present. Today is the tomorrow that was yesterday. I will make today count. 


As the process of education continues anxieties tend to diminish more and more, responsibilities are assumed, and self-esteem is enhanced. 
The patient may be hesitant at first to participate openly with others; however, as soon as group interaction starts, individual anxiety is reduced by positive and sympathetic responses. The participant is allowed to share an intensive experience which, in a climate of openness and trust, requires no defensive role-playing. The participants express mutual concern for one another and, by sharing experiences, each patient can become, at particular times, a therapist for others in the group. In addition, a certain comeraderie is developed, which the patient is not likely to accomplish elsewhere. Carl Rogers, one ofthe chief proponents ofgroup therapy, when asked what is the psychological need that draws people into such groups, wrote: 
I believe it is a hunger for something the person does not find in his work environment, in his church, certainly not in his school or college, and, sadly enough, not even in modern family life. It is a hunger for relationships which are close and real; on which feelings and emotions can be spontaneously expressed without first being carefully censored ...5-P-10 
In a group, psychological and noological growth tends to be promoted; one may learn how to probe for and find meaning where none was thought to exist. 
The case of Mr. N., a 49-year-old accountant, illustrates the benefits gained from participation in a support group based on logotherapy. Mr. N. had undergone by-pass surgery one year before entering our support group. At his first group meeting Mr. N. was filled with anxieties and had a low self-esteem, he appeared vastly uninformed regarding his condition; however, three months later he had achieved a modification of attitudes: "Meeting on a regular basis with peers and discussing mutual problems have made me realize that I am not a cardiac cripple, but a new person -physically and emotionally; therefore, adjustments within my new limits are of utmost importance. There are always alternatives, and the final choice is mine." 
Mr. L., a 55-year-old computer scientist, had also joined one of my support groups, approximately one year after experiencing coronary by-pass surgery. At his first meeting, Mr. L. complained of being depressed most of the time; he was afraid to go to sleep, thinking his heart "would give out." He also complained of frequent cardiac arrhythmias, chest pains, and fainting spells; he did not feel he was "worth much." In addition, he was bulimarexic. 
Approximately six months later Mr. L. had reduced his anxieties; he had a healthier attitude and outlook toward his illness and toward life in general; he became more responsible; and he no longer had any of the physical symptoms he suffered from at his first meeting. Mr. L. further indicated that his relationship with family members had improved, and his self-esteem had been raised to a new high. Also, he was no longer bulimarexic. 
Some additional significant benefits likely to be derived by the cardiac patient from group therapy are cited in a study of former heart patients at the U.S. Naval Hospital, San Diego, California.4 Fifty-seven subjects who had sustained myocardial infarctions were divided into two groups: 36 patients were given group therapy for 3 months, and were studied for a total of 18 months; the remaining 21 patients were established as the control group, receiving no therapy. Results, as reported in Table I, show that therapy-group members experienced lower rates of recurrence and of premature deaths. 
The success of the group and, most importantly, for the individual, depends largely on the ability of the group leader to help the participant acquire a more positive attitude toward life and living, to help the patient search for and find new meaning in life, in spite of physical impairment. For the cardiac patient, living with meaning and accepting what one cannot change is taking a giant step toward optimum rehabilitation. 
From the above it should be apparent that physicians, usually the patients' primary resource, would be wise to consider prescribing patient participation in a support group, one with a strong logophilosophy, as a standard part of the cardiac rehabilitation program. The participants must learn to assume responsibility for their own health-care, and to find meaning in life in spite of any physicial limitations. 
ED WA RD LAZAR, Ph.D., is a medical-care psychologist and the facilitator in support groups whose participants have a life-threatening illness. He is teaching logotherapy at Mount Mary College, Milwaukee. 
REFERENCES 
I. Fabry, J.B. The Pursuit ofMeaning. San Francisco, Harper & Row, 1980. Available through the Institute of Logotherapy. 
2. 
Frankl, V. E. Psychotherapy and Existentialism. New York, Simon and Schuster, 1967. 

3. 
Lazar, E. "Suggested Approaches for an Optimum Care and Rehabilitation Program for the Cardiac OutpatienC Unpublished, 1979. 


4. Rahe. R. H.. O'Neill. T.. Hagan. A., and Arthur, P. "Brief Group Therapy Following Myocardial Infarction: 18-month Follow-up of a Control Trial." International Journal of Psychiatry and Medicine. 1975. 6(3). 349-355. 
5. Rogers, C. Carl Rogers on Encounta Groups. New York, Harper & Row. 1970. 
Table 1 
Effects of Group Therapy on Cardiac Patients 
Post-MI Followups (Reinfarctions or Treatment Control other heart events requiring hospitaliGroup Group zation) (n=36) (n=21) 
0-6 months 7 0-12 months 6 14 0-18 months 7 16 
Source: U.S. Naval Hospital, San Diego, California4 
The Quest for Meaning Among Today's Youth 
Karl Dienelt 

Behind the crisis of our affluent society lies what Viktor Frankl has called the "existential vacuum." We no longer live, as in Freud's times, in an age of sexual frustration. Ours is an age of existential frustration, the unfulfilled claim to a meaningful life, a frustration of the "will to meaning. "5-r 14 Its worldwide existence has been experientally verified 16-r. 230 Several publications point to the fact that this "sickness" of today, the loss of meaning, is spreading across the borders of capitalistic and socialist societies "without a visum. "7-p. 11 This is not a neurosis in any clinical sense. If it is a neurosis at all, it is, as Frankl maintains, the manifestation of a collective phenomenon, an expression of the "pathology ofthe spirit of our times." It is rooted in the doubt about the meaning in life, and in the despair that such a meaning may not exist. 
Frankl does not prescribe a view of life nor does he moralize. He does not attempt to show what the meaning of life is but that life offers possibilities for meanings and values to every human being. "even if all traditions were to disappear and not one single value remain. "7-r. 25 We have to discover the meaning of a situation, which means, we have to comprehend its gestalt. Frankl maintains that meaning has to be discovered and cannot he arbitrarily given. He refers to the gestalt psychologist Max Wertheimer who speaks of the demand quality of a situation and even emphasizes the objective quality ofthis demand. 8
p. 236 
Here Frankl raises a radical criticism ofthe question of meaning. "A question as to the meaning of life in general is meaningless,"he says, "if it vaguely refers to life itself and not concretely in each case to our individual existence. Life itself asks us questions. It is not up to us to raise questions, it is we who are being questioned by life and have to respond to life -by being responsible. "8-r. 72 Thus, the answer paradoxically precedes the question. Frankl then declares that "the same instinct that guides us to our unique tasks in life also guides us to the answers to life's questions, to responsible answers. That instinct is our conscience." And he continues: "The conscience has its 'voice' and 'speaks' to us an undeniable phenomenological fact. The speaking of the conscience, actually, is an answering. Seen psychologically, religious persons are those who perceive the speaker behind the spoken word, and thus are 'keener of hearing' than the nonreligious: in the dialog with their conscience -in this most intimate of all dialogs with the self -God is their partner. "8-r. 7J 
In this connection Frankl's view about an ancient problem of philosophy is worth noting. Regarding the possibility of grasping the meaning ofthe universe, the "goal and purpose" ofthe world in its entirety, Frankl holds that the answers to all these questions are a matter of faith. For the religious person, therefore, the problem does not exist. For the others the problem must first be submitted to a scrutiny on the epistemological level. From the point of view of logotherapy, the meaning of the universe can at best be approached in the form of a borderline concept. Frankl, in this connection, speaks ofa "metameaning. "12·P· 72 
This view also determines the relationship of logotherapy to religion. Religion is seen as a human phenomenon, one among others, whereby logotherapy sees this phenomenon not as a faith in God but as an all-embracing faith in meaning. According to Frankl, logotherapy as a psychotherapy which is part of medicine, is entitled to deal not only with the "will to meaning" but also with the will to ultimate meaning, a metameaning, and religious faith in the last analysis is a faith in metameaning, a trust in metameaning. 12. r 72 
Youth's Susceptibility to Cults 
We now face the question: What part does religion play for the young when we see the human being essentially as a creature in search of meaning? The meaning of religion, declares the German educator Eduard Spranger, is in its looking toward an infinite totality of meaning. Religion "is an attempt to transcend the upper limits of meaning and to assemble the fragments of life which we see as meaningful into a comprehensive interpretation of meaning, either in this world (i.e. within a realizeable existence) or in the beyond (i.e. in contrast to it).20. r-24s 
But we know that the general loss of traditions in our day also obstructs the passing on of religious values and activities. H.O. Wolber, quoted by the German philosopher Hubert Halbfas, stated as far back as 1959 that our society as a whole currently does not advocate religion. "As far as it still encourages religious behavior patterns, these may promote vague tendencies toward an ersatz religiosity. "14-P· 21 It comes as no surprise that the religiosity of youth displays some worldly features. 
If the utterances of our youth often have the character of an ersatz religion, the radical ways in which they pursue the various forms of such substitute religions may indicate that they are influenced by their search for a central meaning which essentially is a religious process. This may be the lesson of the dangerous cult scene which attracts so many young people in their current state of uncertainty. 
The Austrian pastor, Manfred Ach, declared at a church conference in Linz, Austria, as reported in the Kurier of October 3, 1983: "The cults that promise salvation, those dealers with spiritual drugs, endanger state and family." The existential vacuum turns out to be the grazing land where souls are lassoed in by cult leaders who claim to receive an obedience difficult to comprehend. We can only understand this if we consider the basic tendency ofyouth to "assemble (in Spranger's previously quoted words) the fragments of life which they see as being meaningful," and to do this rashly and in oversimplified thinking. Ach agrees when he stated at the aforementioned church conference: "They (the cult members) are convinced that within the world view oftheir masters all problems can find solutions. They follow a miracle cure." 
It is not difficult to see how little we deal here with genuine faith that transcends to a metameaning. Religion becomes idolatry leading to a dehumanization of the youth. When Frankl sees religion or rather a belief in meaning, as a radicalization of the "will to meaning," -where it is a "will to ultimate meaning," to metameaning -then it becomes clear to what plane that "radicalization" of a belief in meaning is reduced which enslaves the young cult addicts. What is missing is the "step into the ultrahuman dimension which is based on 
love. 's. P· 46 
Youth and Drugs 
Young people who are frustrated in their innate will to meaning take LSD they use chemical rather than spiritual means -and all of a sudden the apparently meaningless world bursts into a glow of meaning. But, says Frankl, this is no meaning, merely a feeling or sense of meaning. "Meaning must be discovered, it cannot be manufactured. What can be manufactured is either a subjective sense; i.e. a mere feeling of sense, or nonsense. Thus, persons who can neither discover meaning nor manufacture it, will on their escape from meaninglessness manufacture either nonsense or subjective sense. The former can be found on the stage -the theater of the absurd! -the latter in drug-induced intoxication. But this intoxication holds the danger that these persons will ignore the true meanings, the tasks waiting for them in the real world, and rather 
-r-26
pay attention to the subjective meaning experiences within themselves. 7 
Young people, intoxicated by drugs, are in flight from meaninglessness. Only too often they are also on their way to a slow but painful suicide. There is no doubt, as Frankl has shown, that the feeling ofmeaninglessness has a part in the "quick" suicide. Young people are justified in having doubts about the meaning of life. But Frankl tells them: "Don't be rash in trying direct suicide or trying the indirect painful way through LSD or heroin -have patience. If you make a sincere effort, sooner or later you will become aware of what others also have found out eventually: that life has meaning. Every situation has a specific meaning. For every person a specific meaning is waiting. And this meaning does not cease waiting for you, not until your last breath."5-r-28 
Alternative Life Styles 
Let us turn our attention to a less harmful danger, the socalled alternative life styles. The Austrian publicist Michael Vogler calls fads such as yoga, Zen, and self-discovery groups "self-made salvation. "21 , P· 121 Originally, Vogler says, all these methods had a common aim -to show persons who practiced them correctly and long enough the way to themselves. The fashionable trend of the early seventies, however, attracted insufficiently trained leaders who misused these methods for personal gain. 
The activities of these leaders, according to Vogler, are similar to the formation of the cults. "They present a life philosophy that, once accepted, offers answers to everything. Superficially they give the impression of perfection. In reality they only serve to make a person dependent,on the group or its leader. Those seeking help are not cured as promised but only given the illusion of a false security within the group. It is like a house ofcards that collapses as soon as they leave the group. "21. r-123 
To be sure, yoga and Zen can also be practiced seriously. But today, Vogler says, people flock to yoga mainly to learn something new, to grow spiritually. The popular self-discovery group is a product of Western thinking, a method to achieve self-actualization. In the beginning this was practiced only by a few progressive psychologists but reached an explosive growth in the seventies, spurred on by the interest of the young people who had become fed up with the prevailing consumer mentality. 
These group-dynamic self-discovery courses are said to be part of depth psychology and meant to help people in a mass culture find their threatened identity, the most important goal for youth. This self-discovery movement, having originated in the United States, has not remained limited to psychotherapy but has also entered the field of education.4-r-205 
The psychoanalyst Gunther Bittner calls group dynamics "a sure way to miss oneself. "1 Whatever is meant by the self-discovery movement (it is often called "humanistic psychology"), Bittner sees it as a poorly defined collection of post-analytical therapies, mostly of the group type, which are affiliated with such names as Carl Rogers, Ruth Cohn, Frederick Perls, and Eric Berne. What they have in common, according to Ruth Cohn, is their emphasis on autonomy and responsibility, on "existential partnership" between therapist and client, and on the "here and now." 
The German educationist Hartmut von Hentig sees the danger of these therapy groups in "the readiness of an increasing number of people to take their feelings and thoughts, uncovered by such methods, as an excuse to escape actual tasks, social demands, and political responsibilities. I could also say: These people do not face the moral demands of our society and escape into the disclosure of their weaknesses. And because this is a safe but lonely and unsatisfactory condition, they do it collectively, in groups, in which weaknesses, fears, aggressions, need for love, and envy violently compete with each other and give the impression of great significance. "1s. r. 8 
Frankl, too, comments on this "self-discovery" movement which Bittner sees as symptom and part of the "culture of narcissism." Frankl criticizes the widely misunderstood and abused concept ofencounter as it is often used by humanistic psychologists. 
Frankl reminds us that the existential philosophers Martin Buber and Ferdi
nand Ebner, who originated the concept of encounter, stressed not only the 
significance of encounter but also its character as a dialog. As Frankl points out, 
a genuine dialog cannot take place as long as it does not enter into the dimension 
of the logos. "A dialog without logos is merely a monolog adeux. The partners 
no longer deal with an intentional object but are only concerned with expressing 
themselves. Thus they relinquish self-transcendence which characterizes human 
existence at its core." Frankl understands self-transcendence as the fundamen
tal fact "that to be human means always to reach beyond ourselves toward 
something that is not ourselves --toward something or someone, a meaning to 
fulfill or another human being to lovingly encounter. "6. r 219 
This means, on the other hand, "to the extent to which the human being looks 
beyond himself or forgets himself, he becomes his true self. This is no contradic
tion to the theory of self-actualization. Self-actualization is only possible 
through self-transcendence. "10-r-186 Frankl may even claim that it was Maslow himself who, during the last years of his life, accepted Frankl's criticism by pointing out that his own "experience agrees with Frankl's that people who seek self-actualization directly, don't, in fact, achieve it. The business of selfactualization can best be carried out via a commitment to an important job," says Maslow, admitting that "this descriptive fact can be called the fulfillment of meaning, or self-transcendence. "18 
Task and Example 
Frankl quotes a study by a public research institute in Linz, Austria, which polled thousands of people about who merited their highest respect. "They were not the politicians," reports Frankl "not sports figures, not scientists, not artists, not even astronauts but --leading beyond all others -people who make great personal sacrifices to help others and, not far behind, people who face a difficult fate without complaining. "w That is the opinion of the man in the street, and that is also the personal testimony ofa young man who wrote: "Yes, we may be pampered and spoiled, we are much better off than you were in your youth. But don't forget that we are lacking one important thing: we would need a cause worth committing ourselves to, worth risking everything, a cause requiring a common effort. Or a person who can serve as an example, not just a movie star or a beauty queen."11.p 1ss 
This statement hits the core problem of our youth. Erhard Busek, vice-mayor of Vienna, is correct when he poses the 4uestion. "What tasks are the young of today facing, what example or what meaning is offered to them by our society?" This is also Frankl's view when he says: "They (the young people) need a task and an example of people who fulfill their task. They need models, examples. We can only provide examples; we cannot give values, fabricate values, prescribe meanings. We must be content not to take away meaning through the mass media and through certain playwrights and novelists."9, P-1s4 
To express it conversely: "What we need to be afraid of is not so much an overdemanding but rather an underdemanding of people, especially young people. If they face too little tension, if they are not challenged enough by personal models to find meaning, they will go and look for tension, even if it is only a tension resulting from fear of the police they have provoked."11 r. x111 
Subversive Teaching 
The lack of meaningful challenges for the young may well provide a motivational-theoretical explanation for their deplorable aggressive behavior. But before we deal with Frankl's clear warning to the aforementioned media, playwrights, and novelists, we must discuss the subversive teachings of educational theory that moves along critical-emancipatory lines. 
The Austrian educationist Wolfgang Brezinka sharply criticized this "subversive educational principle" and rejected the big talk ofNew Left teaching with its politicizing criticism of our culture. He said: "The negativism under the pretext of morality will result in a loss of meaning, boredom, and self-pity in some people, and indifference and hedonism in others. The personality damage can hardly be undone through 'nondirective communication' with educators who have no direction and do not want to be educators because they doubt everything. "2. r 177 The "emancipatory education," said Brezinka, made many people aware of the "moral vacuum in our individualistic democracy long before the emergence of the New Left. "2.r 380 It should have become obvious long ago that a "pathology of criticism" (to use the phrase of Th. Wilhelm) cannot cure the pathology of the "spirit of our times." (Frankl). 
We must take a stand against the suspicion which neomarxist indoctrination has raised about the question of meaning: that the crumbling of bourgeois values, "the loss of meaning," merely reflects the crisis of bourgeois society. This view was expressed, among others, in an Austrian television broadcast in August 1978 by Rudi Dutschke and Daniel Cohn-Bendit, the spokesmen ofthe youth rebellion in the late sixties. If we follow the arguments of neomarxist theory, the effort to find meaning is seen as an attempt to preserve obsolete power conditions, and humanistic psychology (including logotherapy) is called a "social glue to overcome the threatened loss of meaning in developed capitalistic countries. "3, r 3 The wellknown Marxist Adam .Schaff, however, has concluded that "the feeling of people to have lost the meaning of their lives" is a phenomenon "which stops at no specific system, at no specific class." He adds the warning: "If we do not acknowledge this, we deprive ourselves of the possibility of recognizing the causes of such social phenomena as violence, 
-r-23
alcoholism. and drug addiction when they become part of society. "19 
A Call for Responsibility 
To come back once more to Frankl's concern about the mass media and certain types of writers: In 1947 he wrote, "Today, when the masses are in extreme spiritual distress it is more necessary than ever to halt that spiritual distress. Not only medical but also cultural-political and religious circles are aware of this responsibility. 1'-r. x Are they? 
"Among the physicians it is the psychiatrist who is responsible for saving our culture," said Konrad Lorenz 1979 in a preface to one of Frankl's books.6· P-ix Elisabeth Lukas. logotherapist and head of a Munich counseling center, wrote in 1981 that these words indicated pessimism as well as optimism. "Pessimism because one has to ask oneself if a culture that needs psychiatry to be saved is not already hopelessly sick; and optimism because Lorenz addresses the one school among all other schools of psychotherapy that is aware ofits responsibility: Frankl's Jogotherapy."11. r-198 
This is why Frankl has the courage to hold up the mirror to his contemporaries and appeal. in strong words, to their conscience. In his address to the annual meeting of the International Pen Club in 1977 he spoke on the theme, "A Psychiatrist Looks at Modern Literature." He reminded the famous authors and Nobel prize winners of their responsibility: "Even if you are not able to use the opportunities of literature to offer therapy on a collective plane, even if you cannot immunize people affected by the existential vacuum against nihilism, then for heaven's sake at least do not infect them with your own nihilism and cynicism. There are theaters today that cannot be called moral institutions, as Schiller did, but on the contrary, when you visit them you would think you are in a psychiatric ward. And nobody deplores this state of affairs because it is "in" to express, with self-pity, one's own nihilism and cynicism. However, this must not be tolerated, and you have to grant me, as a physician, the right to express such opinions. "10. r-1s4 
Where do we hear today such open and courageous words? They prove logotherapy to be a psychotherapeutic school that takes seriously the demand for collective psychohygiene by calling for responsibility. Could these words not help us pull away from an admittedly existing pessimism and to change it into an active optimism? Isn't the situation comparable to the biological pollution which Lorenz, in spite of the pessimism existing also in this area, has called on us to overcome? There is also something like a "spiritual" pollution! Its main victim is our youth. 
KARL DIENELT, Ph.D., wasfor 40 years Gymnasialprofessor of classical philosophy in Vienna. He is the author of several books on education and psychology and has lectured at the Catholic Academy in Vienna. 
REFERENCES 
I. Bittner, G. "Gruppendynamik -ein ziemlich sicherer Weg, sich selbst zu verfehlcn." In: Psychosozial, 1, 1980. 
2. Brezinka, W. "Die 'Emanzipatorische Piidagogik' and ihre Folgen." Piidagogische Rundschau, 35 (60), 1981. 
3. Burow, 0. A. and K. Scherpp. Lernziel: Menschlichkeit, Gestaltpadagogik -eine Chancefur die Schute und Erziehung. Miinchen, Kosel Verlag 1981. 
4. 
Dienelt, Karl. "Ticfenpsychologische Beitriige zur Padagogischen Anthropologie." In E. Adam, ed.: Die osterreichische Reformpadagogik 1918-1938. Wien, Bohlau Verlag, 1981. 

5. 
Frankl, V. E. Der Mensch auf der Suche nach Sinn. Freiburg, Herder Verlag 1972. 

6. 
____ Der Mensch var der Frage nach Sinn. Eine Auswahl aus dem Gesamtwerk. Miinchen, Piper, 1979. 

7. 
____ Der Wille zum Sinn. Bern-Stuttgart-Wien, Verlag•Huber, 1972. 

8. 
____ Arztliche Seelsorge. Miinchen, Kindler Verlag, 1975. 


9. ____ Das Leiden am sinn/osen Lehen. Freiburg, Herder Verlag, 1977. 
10. ____"Derjunge Mensch aufder Sue he nach Sinn." In: Die Jugend und ihre Zukunftschancen. Jugendwerk der Deutschen Shell, Hamburg 1979. 
11. 
____ Die Psychotherapie in der Praxis. Wien, Deuticke, 1975. 

12. 
____ Die Sinn/rage in der Therapie. Miinchen, Piper Verlag, 1981. 

13. 
Frevert, H. Jugend in Selbstzeugni.uen. Baden-Baden, 1960. 


14. 
Halbfas, H. Jugend und Kirche. Eine Diagnose. Diisseldorf, Patmos Verlag, 1966. 

15. 
Hentig, von H. "Habent sua fata libelli." In: Psychosozial. 1, 1980. 

16. 
Lukas, E. "Zur Validierung der Logotherapie." In V. E. Frankl: Der Wille zum Sinn. Bern-Stuttgart-Wien, Verlag Huber, 1972. 


17. ____ Auch dein Leiden hat Sinn. Freiburg, Herder Verlag, 1981. 
18. Maslow, A. H. Comments on Dr. Frankl's paper. Journal of Humanistic Psrchologr. Fall 1966. pp. 107-112. 
19. Schaff, A. Die Sinn/rage in der lherapie. Wien, Europa-Verlag, 1977. 
20. 
Spranger, E. Psycho/ogie des Jugendalters. Heidelberg, Verlag Quelle & Meyer, 1966. 

21. 
Vogler, M. "Das Heil im eigenen lch." In: A. Unterberger, ed .... Alternative Lehensformen in Osterreich. Wien, Verlag Herold, 1981. 


Working With Troubled Adolescents 
Jane R. Silvius 
In any form of psychotherapy the relationship between the client and the therapist is influential, regardless of the mode of intervention. When working with adolescents, this is particularly significant, for the relationship will serve as a medium through which whatever is to happen will occur. The length of the contact is important, however even one encounter will have an impact on the boy or girl. 
In my experience over the past eight years working with young offenders and other adolescents in serious personal turmoil, some characteristics have become evident. These include a rather typical "stripped down" personality, which responds at a survival level in interpersonal interactions. These young people attend to very basic cues in an approach to the world that is often simplistic and embryonic. Projection plays a large part in their perceptions. They are often experientially deprived and poorly educated, having received little opportunity to develop disciplined or responsible attitudes and strategies for dealing with the events in their lives or within themselves. Their role models have often been unreliable and erratic in their behavior. As young children they were obliged to "wing it" and, at adolescence, they must face an onslaught ofdemands for which they had not been prepared, hence they have no resources for dealing with them within or outside of themselves. 
Such a picture presents to therapists a challenge that may well affect their sense of internal equilibrium. Unless they have established a clear sense of purpose and meaning in their lives, they may find themselves depending upon feedback from the adolescent to determine the value of therapy. A situation is then created wherein power becomes an issue, frustrating to the therapist and potentially damaging to the already emotionally fragile boy or girl. This, in turn, reinforces the adolescent's dilemma, because the therapist is unable to fulfill a vital, perhaps crucial, role. In such circumstances, the adolescents are never obliged to confront the question of taking responsibility for themselves because the ego needs of the therapist interfere. In response, they may simply revert to customary modes of dealing with adults, including discounting, ignoring, and invalidating. 
The therapist's alternatives 
In dealing with such situations, the therapists have a range of options from which to choose, such as retreat or a one-up position, unless they have come to terms with the necessity to define their own purpose and meaning in life. Either of these positions will result in belittlement of the clients and their needs, and lead to rejection of the therapist, overtly or covertly. In an institutional setting, conformance may be achieved by coercion, unilaterally determined, which reinforces the pathology ofthe adolescents in trouble through abdication ofthe therapeutic role by adults responsible for them. The relationship becomes custodial, at best. In such cases, it is easy enough to utilize stereotypes and theories which obliterate the necessity for individuals ofall ages to choose their own modes of behavior and accept the consequences that follow. Adherence to a medical model which relieves the adolescents ofresponsibility for choosing the kind of persons they wish to be or to examine the kind of persons they are now presents a significant problem to the therapists in some settings. 
Another unsatisfactory or ineffectual alternative for therapists who are unsure of their own purpose in working with adolescents in turmoil is identification with the clients, in the mistaken belief that this somehow represents acceptance. Most of us working as therapists have had such experiences and know that we must continually guard against their recurrence. Making excuses for clients or identifying with them can be particularly hazardous when they are assaultive, for we may inadvertently give permission to hurt another person by our attitude. 
Two other alternatives suggest something ofa laissez faire stance, wherein the therapists talks with the adolescents without establishing any goals, whether for themselves or their clients. As a result, nothing happens or, more correctly, the adolescent continues to deteriorate, whether or not one recognizes that this is happening. A more troublesome and unethical problem arises when the clients are used to fulfill the therapist's personal needs, which involves self-deception or outright subversion of the therapeutic relationship by the therapist. For instance, the therapist may promote a point ofview in the interests ofany value outside of the well-being of the client, regardless of the objective merit of that value. This sometimes happens in cases of sexual exploitation of children and adolescents, where the therapist's anger toward the perpetrator may require the clients to define themselves as victims as an ongoing definition of personal identity, in order to ensure that the offender's crime is not minimized or forgotten. 
It is evident, then, that the approach to the client reflects the therapist's own substance, as well as the nature ofthe therapeutic intervention to be used. To the extent that the therapists have a clear notion of their own identity, as persons and as professionals, that certainly will influence the quality of the relationship that develops with the adolescent in trouble. 
The role of logotherapy 
What has logotherapy offered to me as a therapist, working with adolescents? First, it provides an organized framework within which to think about experience and the reciprocal influence of individual choice and opportunity. Second, it provides a rationale, to share myself as a person with the adolescent, not as an authority figure or as a peer, but as a fellow human being. I do not have to worry about my "image," and the boy or girl is similarly freed to loosen and perhaps eventually discard his or her artificial self. Neither of us needs to feel defensive or threatened by our uncertainties in the relationship because we have nothing to "prove" to one another or to ourselves. As a therapist, I become a means to an end, and in the process, both the boy or girl and I engage in the creation of ourselves. In The Doctor and The Soul, Frankl says, "One way or another, every situation holds out the opportunity for the actualization of values -either creative or attitudinal values. "Lr 112 He goes on to quote Hebbel, who states, "Life is not anything; it is only the opportunity for something. "1-P· 113 A boy with whom I have recently worked illustrates the relevance of this point to adolescents in trouble. 
Bill is thirteen, learning disabled and severely depressed. He is an adopted child whose parents divorced when he was six. He knows nothing about his natural parents. When his adoptive mother remarried, he was abused by his stepfather. School has been an ordeal for him. Neither parent is willing for him to live with them. He has been made a ward of the government. Bill is awaiting sentencing on a number of charges, and he has expressed a desire to take his life. There is nothing for him to "go back to" because his family has dissolved and there are no other relatives. For children such as Bill, the only basis for "treatment" is to acknowledge the realities of the situation and to provide him with alternative relationships. He will need a great deal of help if he is to be able to accept an offer of friendship or recognize that someone could care for him. The future can offer opportunities to create his life. It will be the therapist's task to convince him that is possible. For Bill to believe it, the therapist must. 
Elisabeth Lukas goes to the heart of the issue with adolescents in turmoil when she says, "Distress does not inevitably cause psychological collapse; it may contain the possibility of finding new (or first) meanings. The psychotherapist today sees that to solve conflicts it is not always essential to dig up childhood traumas or to focus on our unhappy past. It may be more important to widen and strengthen (or bring into existence) the inner meaning orientations of clients so they can grow from distress situations instead of being defeated by them to discover potentials and become more mature ... Instead of exploring the past for reasons clients say 'no' to life, they are helped to find paths where they can say 'yes' to life in spite of all that happened. "3 Logotherapy allows the adolescent to redeem past experience, to integrate it and utilize it, to free himself from it, yet not deny it. 
Nancy was a fifteen year old runaway, whose mother was narcissistic and hypochondriacal and whose father was a violent alcoholic. She was bright but assaultive with peers, behavior that led to a series of institutional placements, in one of which it was revealed that her father had engaged her in an incestuous relationship. Although the intent of the counselling she received there was to ameliorate the emotional consequences of that experience, Nancy used it as a means of achieving personal distinction. She talked about the incest constantly, using it as a rationale for her unwillingness to accede to authority in any form or to acknowledge personal responsibility for her delinquencies. When she was sent to the institution where I met her, she immediately insisted that she be put in contact with a group for incest victims. I was asked to talk with her and in the course ofour conversation, she told me that she intended to make a career of being an incest victim. She became very angry when she learned that neither I nor any other member of the staff would support this aim, but that she would be expected to use her intellectual and other strengths to evaluate her behavior and her life, and to develop a set of positive goals for herself. She was a talented athlete, with natural leadership skills. When she recognized that this was the only alternative open to her and that she was neither viewed as a victim nor would she receive reinforcement for acting like one, she was able to deal for the first time with the exploitation by her father and to work toward its resolution. Because she was presented with a point of view that changed her attitudes, she began to say 'yes' to life, where before she had only been able to say 'no.' 
What is at stake? 
The importance of these issues becomes clear when one looks at the implications and outcomes of the therapeutic relationship between adolescent and therapist. Considering the volatility of the adolescent years, emotionally, behaviorally, and socially, the therapist must always keep in mind the potential ofthe boys or girls to make a suicidal gesture or to take out their frustrations and anger on someone else. Such incidents may have extremely serious and longlasting consequences for the adolescents and for others associated with them, or whoever has been subject of an assault. In some cases, it may well be a matter of life and death. 
Another, and equally important consideration is the therapist's personal integrity. One must address one's own personal and professional responsibilities as they relate to outcomes. The therapist can learn from each encounter. In working with adolescents, therapists have a unique opportunity to explore themselves, and their relationships to and in the world. The adolescents can be given the opportunity to discover their own potential to create a life, to participate productively in relationships, and to fulfill the promise that was present at birth. Logotherapy offers a means of facilitating these discoveries and, in addition, can have lifelong implications as a set of principles which guide the adolescent clients away from a self-perception of victimization and its pernicious companion, a victim mentality. 
In sum, the therapist working with troubled adolescents has the moral obligation to accept responsibility for voluntary involvement in the lives of boys and girls, while recognizing and enjoying the opportunity to introduce them to ways in which they may derive meaning and satisfaction from their experience, past, present and future, as it enables them to discover their own unique purpose as human beings. 
JANE R. SJL VJUS, Ph.D.. is director (psychologist) at the Child Development Centre. Edmonton, Alberta. Canada. 
REFERENCES 
I. Frankl, Viktor. The Doctor and the Soul, NY, Vintage Hooks, 1973. 
2. Lukas. Elisabeth. Meaninf!ful livint-:, Berkeley. Institute of Logotherapy Press, 1984. 
The Explosion in Meaning 
Robert E. Carter 

Viktor Frankl has long recognized that human freedom of will is one of the necessary preconditions of logotherapy. 2 He has made vivid the realization that we can choose to live meaningfully and to enrich our lives even when our external freedom is taken away by extreme circumstances as exemplified by those at Auschwitz. Indeed, whatever our circumstances, it is only when we become conscious of and responsible for our free choice that meaning in our lives can grow and deepen. Otherwise, we simply go through the motions of living, as victims who are at the mercy of others, as casualties in the working out of fate, as patients suffering from the hang-ups of parents or siblings, or as alienated or angry human beings because ofthe evils ofsociety. All such stances serve to deny our freedom (as the existentialists say), and to hide from us the truth that we have the power to react to such causal and environmental conditions in creative and unpredicted ways. We can transcend them, render them meaningful in spite of their hold and horror, and thereby change our way of being-in-the-world. 
An example might assist. Over the past several years, the Philosophy Department at my University has organized a lecture and seminar program at a near-by correctional institution. The group is called the "Life-Servers", indicating that most are in prison for murder. One ofthe areas that interests them most is Zen Buddhist philosophy. I would speculate that this is so because Zen is an incredibly introspective approach to self-understanding. The prisoners often joke with us about how much prisoners and philosophers have in common: both spend unusual amounts of time thinking -about themf>elves, their condition, society, morality, and the meaning of life. Philosophers choose to reflect and introspect; prisoners "are forced" to do so simply to fill up their time and to work out why they are where they are. In time, they will also reflect upon the future -but not at the beginning of a 20-year term. Ironically, then, by having had their external freedom taken away, many have "been forced" to discover the only freedom which cannot be taken away -inner freedom, or freedom of conscious reflection. And here is the example I promised. In my lectures on Zen, I pointed out that our attitudes toward situations are heavily the product of our culture and, therefore, our expectations. I described how sense-deprivation experiments cause people from the Western world to panic, for without any input from the outside (through the senses), the mind begins to panic, to race, to hallucinate, and to fear. But meditators from the eastern cultures did not pull the emergency cord in a few minutes, but basked in the stillness for hours, alone with themselves in a state of meaningful bliss. Indeed, Japanese Morita therapy (a form of Zen-inspired psychotherapy) begins by 
placing both ordinary and severe psychological cases (including schizophrenics) in solitary confinement for up to two weeks. Patients are instructed to confront their problems, such as sorrows, phobias, grief, anger, or hatred, and to experience them fully, face to face as it were, by themselves. Then, they begin to chart their own solution, and to identify their own meaning for the future. For the prisoners, the point of the discourse was that what one culture considers punishment, another may think of as therapy! The circumstances are more or less the same (although imprisonment is, of course, not just therapy, nor is it for two weeks), but the attitudes are radically different. While circumstances may be beyond our control, our attitudes toward circumstances are very much ours to determine. Of course, even they often seem to "happen" to us, but any breakthrough in understanding may yield a transformation in our attitudes as well. This is what happened with a few of the inmates -they began to think of quiet time as therapy time, and not as something to avoid or fear. Even solitary confinement, the most feared of punishments, became for some a possible occasion for growth. I was told by those who had already begun to discover possibilities in isolation that a lengthy stay "in the hole" had made them more sensitive to sounds, smells, textures, and that when they emerged many days later, the world literally burst upon them with its vivid colors, cacophony of sounds, lights and shadows, and textures and shapes beyond imagination. They had never told such stories before because they thought such experiences to be the stuff of madness. But I was telling them that such was the stuff of meaning and health. They could see that now. 
In the occasional visits that followed, I often heard from inmates who were developing full and rich introspective lives for themselves, while continuing with the nearly constant routines of prison life. They were not denying their situation, but were discovering a dimension ofthemselves which was not imprisoned. Like Albert Camus' Mersault, himself a prisoner (awaiting execution), "... gazing up at the dark sky spangled with its signs and stars,Jor the first time, the first, I laid my heart open to the benign indifference of the universe. "1 Everything shimmered with meaning -that is, everything took on new meaning, for the restrictive attitudes had changed, as the chains of custom, habit, expectation and the humdrum were broken. It may take a crisis, an execution, grief, the smile of a child, or the touch of a lover to awaken us, but when the awakening comes it transforms old limits into an explosion of new meaning! The compulsions ofour past gives way to self-determination ofthe future. What "Mom"did to us gives way to an understanding of her problems, and from her perspective, leaving us free to decide who it is that we will become. We are free to become whom we wish, to the extent of our vision and energy. So it is that Mersault is finally able to say, "almost for the first time in many months, I thought of my mother. And now, it seemed to me, I understood why at her life's end she had taken on a 'fiance'; why she'd played at making a fresh start. "1 All starts, all activities are fresh if we reflect upon them as though for the firt time, and choose them anew. Thereby we transcend the old meaning and hold of the past. We have actually reached into the past, into the habitual and automatic, rethought its nature and remade its significance, influence, and meaning. In so doing, we may well alter our understanding of many other events in our life, for a shift of understanding in one area often has a domino effect on many others. Each new 
insight, or major experience, or telling comment, or critical comment from another, or marriage breakup, or a death may shake loose an old way oflooking at things, and the ripples from this new realirntion may wash all the way back to childhood. A small change in perspective or attitude may unleash a chain reaction -a virtual nuclear explosion within -which transforms the way we look at, experience and appreciate whole features of our lives, others, and our environment. Our capacity for meaning has been enlarged, and the process has a tendency to be self-propelling. Now that transformation has begun, the chemistry seems to be such that the freedom to "let go" and to "look again" seems to be just that much easier and more frequent; it may well continue, and to amplify throughout an entire lifetime. It is for reasons such as this that I urge that freedom lies within consciousness ~-the seat of introspectivity -coiled like a snake in sleep, and invisible to the ordinary eye. For many people, perhaps even for most, it does not stir, but sleeps on through the chilled boredom and habituation of their lives. It can be awakened, however, and the logotherapist, 
teacher, friend, or lover each have the power to awaken what lies deep within the dormant will to meaning. 
ROBERTE. CARTER, Ph.D. is professor ofphilosophy and chairman. Trent University, Peterborough, Ontario, Canada. 
REFERENCES 
l. Camus, Albert. The Stranger. New York, Vintage Books, 1959, pp 153-154. 
2. Frankl, Viktor E. The Will to Meaning. New York, The New World Publishing Co., 1969, p. 68. 
The winner of the third Viktor Frankl Essay Contest sponsored in 1984 by the Institute of Logotherapy for high school seniors in California was Philip A. Dinauer of the University of San Diego High School. The following is the prize-winning essay. 
Rehumanizing the Computer Age Through Logotherapy 
Philip A. Dinauer 
The creation of the computer marked the dawning of a new age -the "Computer Age." Today, as we witness the growing influence of computers in human affairs, it is the role of logotherapy to inquire into our relationship with our creation. Is there a sense ofemptiness, of meaninglessness, and ofdehumanization that must be addressed in this age? Does technology threaten to enslave us to our scientific toy? And, if the answer to these questions is yes, how can logotherapy act as a catalyst to educate the human being, to rehumanize the Computer Age, and thereby open new doors to higher realms of human experience? 
To rely on the computer to define our humanity would be to deny the human capacity to adapt and to rise above our creations. Could this be the greatest threat that the computer poses to humanity? I believe that logotherapy's primary concern in this age is that we may not be strong enough, wise enough, nor moral enough to cope with the powerful scientific tool that we have created. The computer has already spread out into a myriad of human affairs, and in a world of constantly changing conditions it is unknown whether we wiJJ be able to establish a healthy self-concept or a positive perspective toward the computer. 
Two aspects which make the computer so attractive are its wide usability and its incredible potential. One reason why the computer has great potential is that it is modeled after the human dimension of logical high-speed data analysis.Just as we empirically absorb data from our universe, process that data, and then analyze it, the computer is able to intake, process, and analyze data as well. However, although we and the computer may share in the logical realm of data processing, our humanness gives us dimensions which clearly transcend those of the computer. 
A distinction of the human being from the computer is found in our capacity to discover meaning in various situations. According to logotherapy, our quest for meaning prompts us to constantly question the meaning of life. Each unique moment presents a unique meaning, and it's up to each of us to find our own personal meaning to existence. Whereas we can really experience the beauty of a sunset, the uniqueness of another human being, and the act of loving, a computer cannot. This points to the fact that meaning is a subjective experience; the computer, as object, cannot touch the realm of meaning experience. Thus, our experiences give us a mode of meaning discovery. 
Life is a process of constant change, and in the face of that change we have a responsibility to confront each passing opportunity to realize our potentialities. 
One of the major ways in which we find meaning is in the application of our creative mind. Logotherapy asserts that it is this human dimension which allows "man to reach out beyond himself and make his aspirations and ideals part of his reality ..."1. r. 18 Human creativity gives rise to products such as the computer; that is, the computer can be seen as a by-product of the superior human intelligence. Once the creative mind brings an object into the world of physical reality, that object can be used to help us discover further creative capacities. Specifically, the computer can serve as a tool that can point out further conditions to be faced and even greater potentialities to be actualized. 
However, the view of computers as tools for human discovery and selfactualization is not a conventional one.Not all people see the computer merely as a by-product of human intelligence. Rather, they see the computer as a dehumanizing force which contributes to the "existential vacuum. "1, r. 81 Instead of advancing the human being to greater domains ofexperience, computers are seen to be drawing us away from our humanity. 
One aspect of the computer is its ability to change problems dealing with words into problems dealing with numbers. Whereas some values can be intrinsically better than others, numbers cannot. As Ken Wilhur points out: 
Love is intrinsically better than hate, but three is not intrinsically better than five. And thus, once you have translated the world into empiric measurement and numbers, you have a world without quality, guaranteed. Which is to say, without value or meaning. 3. P· 26 
In a dehumanizing age of science and technology, there is a proclivity to view 
human beings as closed systems who cannot rise above themselves. Because the 
computer translates a world of real human beings and real human experiences 
into a binary language, we are reduced to a lower dimension. A three
dimensional object projected onto a flat plane always gives a two-dimensional 
image. In a similar manner, the human being, an open system, can be projected 
into lower realms. Since the world of quality and meaning cannot be translated 
into number symbols, logotherapy must teach us to rise above symbols and 
enter the dimension of actual and direct meaning perception through personal 
expenence. 
To direct us toward a healthy life in the Computer Age, logotherapy must 
help us see the computer as a binary tool. This understanding of computer as 
tool allows us to be more perceptive ofthe computer as a means, rather than an 
end. The computer is already used as a means of communication and interac
tion among human beings, and it is possible for us to further adapt the computer 
to the satisfaction of human wants. It's even possible to view the computer as an 
instrument of helping dialogue between people in the Computer Age. 
One of the roles oflogotherapy in the Computer Age is to teach us to use our 
binary tool both responsibly and wisely. If we are not responsible with our 
scientific toy, we may lose control of it. There is the threat that we will allow the 
computer to be raised to a higher level than ourselves where it will control, 
enslave, and dehumanize us. 
In addition, logotherapy must teach that although we are not free from 
conditions in the Computer Age, we are free to establish a position toward those 
conditions. We must adapt to this age lest we become enchained by it. Also, we must not surrender our creative and experiential dimensions that make us human. To do so would be to become the "programmed" instead of the programmer; yet, one of our unique features is our ability to resist such programming, and we do this by using our mental structure to help shape our world. 
The human capacity to change ourselves, to transcend, and to rise above our condition is what makes us human. Frankl writes: 
Because of the transcendent quality of human existence ... being human always means being directed and pointing to someone other than itself.2, r 25 
Therefore, in an age centered around computers, we are presented with the challenge to open ourselves up, to transcend, and to enter the human domain. 
Ultimately, logotherapy can rehumanize the Computer Age by acting as a stimulant in educating us to rely on our personal conscience. Logotherapy must stress our experiential side that allows us to directly experience meaning. Another aspect, that of intuitive conscience, also acts as a mode through which we can experience personal meaning. 
This interpretation of conscience as a personal, intuitive outreach into the world of unique meaning potentialities makes it ultimately the instrument of human progress. 1. p. 79 
In the final analysis, the human being as an open system, must reach out in the Computer Age for meaning: to encounter another human being, to serve a cause, to create, or to find a person to love. We must recognize that computers are tools which can, when used wisely and responsibly, help us to efficiently complete tasks, to aid dialogue and communication among human beings, to stimulate human creativity, and to thereby advance us to realms of greater human experience. Lastly, in our quest for meaning, we must refer to our conscience to guide us through the Computer Age, and we must rely on ourselves to define what it means to be human. 
REFERENCES 
I. Fabry, Joseph B. The Pursuit of Meaning, San Francisco, Harper & Row. 1980. Available through th~ Institute of Logotherapy. 
2. 
Frankl, Viktor E. The Will to Meaning. New York, The World Publishing Company. I 969. 

3. 
Wilbur, Ken. Eye to Eye. New York, Anchor Books, 1983. 


Humor in Logotherapy 
MichaelF.Shaughnessy 

This paper considers the role of humor and laughter in paradoxical intention and logotherapy, and investigates their use in therapy. It examines our transcendental ability to "rise above ourselves" through humor and offers suggestions for improving our condition through laughter and fun. 
One of the best-known stories of "cure" by humor and laughter comes from Norman Cousins.2 He tells about his recovery from a near-fatal illness, a collagen disease, and extreme pain. His prognosis was guarded but in cooperation with his physician he developed his own treatment, one aspect of which was "humor therapy." 
Cousins watched comedy films and movies ascertaining that periods of laughter resulted in hours ofpainles sleep. Sessions of laughter and fun reduced inflammation, and these effects were cumulative. He monitored his diet, watched "Candid Camera" repeats and Marx Brothers films and read many humorous books. His health was restored. 
Paradoxical Intention 
The role of humor in paradoxical intention has been extensively documented. Lazarus9 stated that "an integral element in Frankl's paradoxical intention [is] the deliberate evocation of humor. A patient who fears that he may perspire is enjoined to show his audience what perspiration is really like, to perspire in gushes of drenching torrents of sweat which will moisturize everything within touching distance." 
In paradoxical intention, it is essential to "mobilize and utilize the exclusively human capacity for humor. "7 The patient is thus, via self-transcendence, able to "develop a sense of detachment toward his neurosis by laughing at it. "6 Gordon Allport maintained that "the neurotic who learns to laugh at himself may be on the way to self-management, perhaps to cure. "1 
By laughing at our problems, miseries and sufferings, we can minimize them or at least perceive them in proper perspective. 
Frankl quotes from a paper by Mohammed Sadiz:7 
Mrs. N., 48, diagnosed as hysteric, had body shaking. She could not hold a cup ofcoffee without spilling, could not write nor hold a book firmly enough to read. One morning she was sitting in front of the therapist, trembling and Afterwards, whenever I would see her shaking I would say, "Come on, Mrs. 
shaking.  
Therapist:  How would you like to compete with me in shaking, Mrs. N.?  
Patient:  (Shocked): What?  
Therapist:  Let us  see  who  can shake and tremble faster and for how  
long?  

Patient:  Are you suffering from these shakes, too?  
Therapist:  No, I am not suffering from them, but I can tremble if I want  
to. (I began to shake.)  
Patient:  Gee. You are doing it faster (trying to speed up and smiling).  
Therapist:  Faster, come on, Mrs. N., faster.  
Patient:  I can't. (She was becoming tired.) Quit it. I can't do it any 
more. (She got up, went in the dayroom, and brought herself  
a cup of coffee. She drank the whole cup without spilling it  
once.)  

N., let's have a race," and she would say, "O.K. It sure works." 
The absurdity of the situation and the patient's neurosis is clear in this 
example. Some situations, problems and difficultie are easier to mock and place into perspective than others. Frankl could show t!iat even under the extreme and brutal conditions of the concentration camps humor could be employed as a survival tactic. He reports: 
"Humor was another of the soul's weapons in the fight for self-preservation. It is well known that humor, more than anything else in the human makeup, can afford an aloofness and an ability to rise above any situation, even if only for a few seconds. "s 
Thus, humor is part of the arsenal of logotherapists in their quest to assist the patients in rising above and transcending their plight. However, the incorporation of humor into the therapeutic armamentarium is a difficult task indeed. 
Frankl recounts: 
"I practically trained a friend of mine who worked next to me on the building site to develop a sense of humor. I suggested to him that we would promise each other to invent at least one amusing story daily, about some incident that could happen one day after our liberation. He was a surgeon and had been an assistant on the staff of a large hospital. So I once tried to get him to smile by describing to him how he would be unable to lose the habits ofcamp life when he returned to his former work. On the building site ( especially when the supervisor made his tour of inspection), the foreman encouraged us to work faster by shouting: "Action! Action!" I told my friend, "One day you will be back in the operating room, performing a big abdominal operation. Suddenly an orderly will rush in announcing the arrival of the senior surgeon by shouting, "Action! Action!"5 
To see incongruity in situations may invoke humor. This tactic has been documented by Knaus8 and can be used to evoke humor. Often the use of"time projection" as documented by this author 11 can also be used to provoke a humorous scenario. Frankl says that 
"sometimes the other men invented amusing dreams about the future such as forecasting that during a future dinner engagement they might forget themselves when the soup was served and beg the hostess to ladle it "from the bottom."5 
The juxtaposition of the future and the present is an effective tactic to elicit humor. 
A Weapon in the Therapeutic Arsenal 
Other therapists have also documented the use of humor as a weapon in the therapeutic arsenal. Albert Ellis 3 lists the following advantages of using humor in psychotherapy: 
"l. Humor can help clients laugh at themselves and thereby accept themselves with their vulnerabilities and fallibilities. 
2. 
It clarifies many of the client's self-defeating behaviors in a nonthreatening acceptable manner. 

3. 
It provides new data and potentially better solutions, often in a dramatic, forceful way. 

4. 
It relieves the monotony and overseriousness of many repetitive and didactic points which often seem essential to effective therapy. 

5. 
It helps clients to develop a kind of objective distancing by participating in the therapist's humorous distancing. 

6. 
It dramatically and rudely interrupts some of the client's old, dysfunctional patterns of thought and sets the stage for using new more effective patterns of thinking, emoting and behaving. 

7. 
It helps many clients paradoxically think and act oppositely to their usual ways and thereby enables them to do many things, such as behave unanxiously, that they think themselves unable to do. 

8. 
It serves as a distracting element that will at least temporarily interrupt self-downing and hostility-creating ideas. 

9. 
It shows people the absurdity, realism, hilarity and enjoyability of life. 

10. 
It effectively punctures human grandiosity -quite a disturbance in its own right!" 


Humor and laughter are effective in therapy because they also affect the organism, as Peter and Dana have shown: 
"Mirth and laughter stimulate the brain to produce catecholamine -the alertness hormone, a complex substance that includes epinephrine norepinephrine and dopamine which prepare us to respond physically for either fight or flight. The arousal hormone in turn stimulates release of endorphins -our natural painkillers. As the level of endorphins in the brain increases, the perception of pain increases. Laughter, then, causes our bodies to produce our own painkillers. "10 
Thus, laughter coupled with logotherapy may assist us, not only psychologically, but physically as well. As brain research continues, we may find even more beneficial effects of a good laugh, a funny joke, or a humorous story. 
Peter and Dana10 speculate that humor: 
• 
has the power to reduce tensions and to create a relaxed atmosphere 

• 
provides an outlet for otherwise unacceptable feelings, behaviors and impulses by facilitating talking about or acting out conflicts or emotions in a safe non-threatening way 

• 
puts us in a frame of mind conducive to constructive interchange with others 

• 
encourages communication on sensitive matters 

• 
can lead to insight into causes of conflict and emotional disturbances. 


Relevance of Humor 
Whether humor can help individuals understand themselves depends on the degree of humor's relevance, not on the degree of fun generated. Comedy is effective in getting people's attention away from their problems, and relevant wit helps them in facing their problems. For example: 
• 
A depressed guilt-ridden young man told Dr. Alfred A. Bach, 'I am the kind of guy who just doesn't appreciate his parents. I must be worthless." Dr. Bach replied: "It is hard to appreciate parents who turn out such a worthless product. "JO 

• 
A self-pitying man said, "I feel anguish and indecision. If I give up being a nice guy, I'll have to give up getting sympathy." Dr. Bach responded, "I can sympathize with you. "10 


These examples hold the element of paradoxical intention. This method can be used effectively in therapy and perhaps even in our daily lives as we battle machines, combat the bureaucracy, and deal with traffic jams. 
Allan Fay also documented the use of humor in therapy. One of his clients was 
"a brilliant young graduate student who was 75 pounds overweight was so terrified of rejection that he had never approached a woman for a date. I asked him to write a scathing denunciation of himself as part ofa program to desensitize himself to criticism and rejection. "4 
He wrote it in the form of an introduction: 
Folks, I would like to introduce a man -if you can call him that without getting sick -who is unsurpassed as a sniveling, slobbering, groveling, wallowing, simpering, whining, effeminate, amorphous wad of adiposity -a ball of blubber --a tub oflard -a steatopygic (fat buttocked), gynecomastic (female breasted) mama's boy -a phony spineless, pseudointellectual, supercilious, unctuous, slimy cretin, terrified of his own shadow -an ambulatory mound of lasagna -a giant turd on the hoof with vestigial microphallus. A lactating hippopotamus would be insulted by the comparison. In short, he defies description. We must decide whether he merits our pity or our contempt. Can even the staunchest Christian tolerate this pathetic worm?" 
Although this exercise was only part of a total program, the client did lose weight and began a more social life. 
Fay has also utilized humor, coupled with paradoxical intention, in the treatment of delusions and paranoia.4 
A 60-year-old man, convinced he was suspected of stealing money from the bank at which he was employed, was positive he was being followed and was terrified of imminent arrest. He was scrupulously honest. I asked him to bring his wife to the next session. She was exhausted from her efforts to reason with him. 
Patient: They're after me. 
Wife: (benevolently) No, Louis, they aren't. You didn't do anything wrong. Besides, why would they pay people thousands of dollars to follow you around day and night? If they really wanted to get you they would have done something long before now. 
I suggested that she respond as I did: 
Patient: They're after me. 
Therapist: They certainly are. Not only is that bank after you, but they have notified other banks in the metropolitan area as well. A city-wide alert is out on you. The police have been notified and the conspiracy has already extended to the F.B.I. Countrywide, agencies are focused on you and are trying to get you. Even Scotland Yard and Interpol are interested in your case. There is no question that you are going to be arrested very soon. We should contact a lawyer immediately. Of course you will be convicted, but you need a lawyer anyway." 
In both ofthe aforementioned cases, humor and laughter enabled the client to transcend his difficulty. If Freudians believe dreams to be "the royal road to the unconscious," logotherapists see humor as the "royal road to transcending their problems." 
For those not in therapy but who do want to use humor in their lives, Peter and Dana 10 offer the following suggestions: 
• 
Start a collection of happy and humorous memories. 

• 
Reminisce about happy incidents of your childhood. 

• 
Remember amusing things that happened at home and at school. 

• 
Recall the pranks your co-workers played or funny things that occurred. 

• 
Include any experience that made you laugh or feel good -an anecdote that someone told, a happy circumstance, a comical event. 


Just as logotherapy emphasizes the perception of meaning, it may be important to perceive humor in our daily lives and experiences. Humor can add immeasurably to the human condition in this technocratic age. We shall, of course, need empirical data to substantiate my claim but I believe that humor can help us transcend problems and difficulies and help logotherapists assist clients in their self-transcendental search and their search for meaning. 
MICHAEL F SHA UGHNESSYis assistant professor ofpsychology at Eastern New Mexico University, Portales, New Mexico. 
REFERENCES 
I. Allport, G. llie Individual and his Religion. New York. Macmillan. 1950. 
2. Cousins, N. Anatomy of an Illness, as Perceived hr the Patient. :\ew York, Norton Publishers. 1979. 
3. Ellis, A. "Fun as Psychotherapy." In Ellis, A. & Grieger. R. et al. Handhook of RationalEmotive Therapy. New York. Springer Publishing Co., 1977. 
4. 
Fay. A. Makin!; Thing5 Better hr Making 1hem Worse. New York. Hawthorne Books. 1978. 

5. 
Frankl. V. E Mans Search/or Meaning; an lmroduction to I.oxotherapy. Boston, Beacon Press. 1962. 

6. 
----· Psychotherapy and Existentialism. New York, Simon and Schuster. 1967. 

7. 
----· The Unheard Crrfor Meaning. New York, Touchstone. 1978. 


8. 
Knaus. W. "Cognitive Behavioral Strategies for the I herapeutic Armamentarium." Rational Living, JO. p. 41-43, 1975. 

9. 
Lazarus, A. A. Behavior 771erap_1· and Beyond. New York, McGraw Hill. 1971. JO. Peter.Land Dana, B. The Laughter Prescription. New York, Ballantine Hooks, 1982. 


11. Shaughnessy, M. 'The Creative Therapist. Creative Child and Adult Quarterly, 2. p. 85-92. 1981. 

Combating Stress and Burnout Among Correctional Employees 

Leonard E. Miller and Steven T. Adwell 
During the past years, attention has been focused on occupational stress and burnout. The concept of stress and its major physiological component were conceived by Selye 24 in his initial work on the general adaptation syndrome. 
Selye later reaffirmed stress as "the nonspecific (that is, common) result of any demand made on the body, be the effect mental or somatic. "26 He also spoke ofstress as "the wear and tear of life. "25 His general adaptation syndrome (GAS) states that all living organisms possess a set quantity of energy to adapt to environmental exigencies. Various activities of living cause the "wear and tear" which diminishes that limited adaptive reserve: individuals who draw too rapidly on their nonrenewable life resources die prematurely or become ill.26 
The term "burnout" first appeared in professional journals after Freudenberger13 researched burnout among volunteer social agency staff who worked outside conventional helping organizations. This work led to broader applications of burnout explanations of attrition across a wide sphere of human services. As stress-related (psychophysiological) disorders, specifically coronary heart disease, emerged in modern industrialized societies (currently accounting for one-third of all deaths),9 occupational stress research gained momentum. However, management in many occupational areas has remained wary of the potential impact of findings for sensitive areas, such as retirement and salary negotiations. 4 
Fortunately, this has not been true in the criminal justice field. Much of the initial stress/ burnout research has focused on law enforcement personnel, specifically police officers. Professional publications and research have focused more on police than their less visible counterparts, the correctional employee. Primarily because of the pioneering work of Cheek and Miller, 8 an empiricallybased body of knowledge has emerged, which addresses stress and burnout among persons working in correctional settings. The present writers are indebted to Cheek and Miller for providing the data base, assessment techniques, and heuristic impetus from which their Kentucky study arose. 
Cheeks and Miller6 reported higher rates of stress-related physical and emotional illness, impaired job performance, and marital disruption than earlier research had detected among police officers. 16 Their further study7 of correctional officers from four representative states provided a definitive picture of occupational stress and burnout in a correctional environment. In a recent article,5 Cheek summarized the implications of her research on correctional officer stress. Correctional officers are more at risk in numerous life areas than the general population. Not only is their likelihood of heart attack, ulcers, and hypertension greatly increased by their profession, but their life span is reduced to 59 years compared to 75 years for the general population. 2 
The Kentucky Study 
In July, 1983, the authors undertook a study with the following purposes: ( 1) to determine empirically the levels of stress and burnout experienced by state correctional employees through the use of a comprehensive stress/ burnout instrument using a controlled methodology, and (2) to research the relationship between the existential construct "purpose in life" and stress/ burnout in the same applied setting. 
This study was conducted at the Luther Luckett Correctional Complex near Louisville, Kentucky. The complex is comprised of two separate facilities: a close security adult correctional institution and a maximum security forensic psychiatric facility. The two institutions are state-operated (as were the institutions in which Cheek conducted her research) and share specific resources designated through written agreement. The complex, which opened in March, 1981, has a capacity of 480 persons in the correctional component and of 98 persons in the psychiatric facility. The correctional institution is accredited by the American Correctional Association; the forensic facility is licensed. 
The setting afforded an opportunity to assess stress and burnout across institutional, as well as occupational, lines. No stress/ burnout research had been conducted in the Commonwealth of Kentucky prior to the research at the Luckett Complex. 
The survey population consisted of the total staff from both institutions. The investigators placed all institutional staff at both facilities (correctional and forensic components) into the following categories: 
1. 
Administration -administrative and support service staff; 

2. 
Custody -custodial and ancillary maintenance staff; and 

3. 
Program -treatment, classification and related services. 


Participants were selected randomly from their category by facility. Approximately one-third, or 114, staff participated. 
One week before the collection ofdata began, all employees at both the prison and the forensic hospital received a letter signed by the superintendents of both institutions stating that a stress/ burnout study would soon be conducted, that selection for participation would be random, that participation was voluntary, and that the anonymity of respondents was guaranteed by law. The announcement was to prevent rumors and to avoid biasing respondents toward the proposed project. Most of the sample population were not informed that they had been drawn for participation until shortly before the tests. 
The instruments were administered in a closed room (selected to control distractions) with small groups. Small-group administration was necessary because all data were collected during respondents' regular working hours which necessitated leaving their work area. This way of collecting data assured that normal working operations were not disrupted and that respondents were not, as in Cheek's Prisoners ofLife Study, 8 required to donate personal time. All groups were monitored by one of the researchers to answer questions and insure consistency of application. To assure confidentiality, code numbers were used instead of names. 
Two instruments were administered to each subject. The first was the Cheek/ Miller instrument measuring the respondent's experience of stress in terms of physical health, emotional and interpersonal relations, job performance, and perception of stressors within the correctional millieu. Thus, Cheek's instrument approached stress and burnout from a comprehensive perspective. 
The second instrument was the Purpose in Life (PIL) test. I0 The first writer, for more than a decade, had found logotherapeutically-derived constructs useful in assessing and treating a variety ofclinical populations suffering from a lack of meaning, coherence, and experiential continuity in their lives21 conditions subsumed under Frankl's "existential vacuum". I1 It is significant that logotherapy had been tested by Frankl's incarceration in the prison system of Nazi Germany. That psychologists in both popular22, 23, 27 and scholarly works 17, 19 have cited existential thought, among them logotherapy, as possessing relevance for stress/ burnout related issues of human coping and health confirmed the authors' decision to include the PIL test in their research. Indeed, reviewing current descriptions of burnout causes one to wonder whether the "existential vacuum," the manifestation of the failure of the "will to meaning,"12 might afford a more universal construct from which to launch investigations about burnout in correctional and other work settings. Although the PIL test has psychometric deficiencies, it does measure an independent personality variable and has enjoyed wide use in clinical and research settings. 28 For this study, the investigators wished to determine whether the PIL test correlated significantly with scores on Cheek's stress/ burnout survey. 
Findings 
Employees of both institutions within the correctional complex obtained stress/ burnout scores comparable to Cheek's nationally-derived figures. Kentucky, along with most other states, fell into the third quartile (with the first quartile being the lowest and the fourth quartile the highest level of burnout). In examining nutrition and physical exercise scores, Kentuckians produced the lowest. Job satisfaction was, in seeming contrast, higher than those previously researched. 
No statistically significant difference was found between staff scores from the prison and the forensic facilities. Neither did scores on the stress/ burnout survey differ significantly among the divisions of Administration, Custody, and Program. Thus, stress/burnout score differences did not appear to be a function of contact with inmates, as implied by the thrust of Cheek's work. 
The most significant discovery was the extremely high correlations between PIL scores and scores on various domains of Cheek's survey. A correlational analysis (Pearson r) was used to examine the relationship. Five areas are listed below with their respective correlations (r). The correlations arc significant beyond the .01 level. 
Domain Correlation with PIL 
Burnout -.6183 Selye Health Score (the lower 
the score the more health  
indicated)  -.5027  
Nutrition Score  .4895  
Physical Exercise  . 3193  
Job Satisfaction  .5113  

From a statistical view these levels are uncommonly high. The findings, therefore, may hold important implications for future practice and related research. 
With a possible raw score of 140, the mean PIL score for the sample population was 102.5. This sample fell within the "indecisive" range using normative data offered by the test publishers. PIL raw scores of92 through I12 indicate indecisiveness about purpose in life. Scores above 112 indicate the presence ofa definite life purpose. 10 The PIL scores in this study were lower than those designated as within the "normal" range by the test authors. This finding causes one to consider the relationship between lower levels of perceived meaning and working in corrections, "an environment viewed as unequivocally negative. "1 
Discussions and Implications 
Although this research was not the first to address occupational stress and burnout from the perspective of existential concepts, it did constitute an initial attempt, at least in a correctional setting. to demonstrate statistically a significant relationship between stress/ burnout and purpose in life in a naturalistic environment. 
The results ofthe Kentucky study have caused the authors to rethink a major theoretical issue in modern occupational stress research: whether to think of stress primarily as a mixture of noxious environmental (external) conditions or as a reaction of the individual which creates a disturbance of normal functioning. Selye preferred the latter designation, but most social scientists have promoted stress primarily as an environmentally generated phenomenon. 15 The prominence of cognitive psychology (focusing on thought processes) in recent years emphasized the role of individual thought/perception in determining sources of stress as well as the total impact of the perceived stressor on the individual. 14-20 
Concern is rapidly shifting from an almost exclusive attempt to improve external work environments to a relatively new emphasis on assisting individuals to control stress by various coping strategies which alter the stress experience. One recent work lists forty methods -from psychotropic medication to biofeedback to various forms of relaxation training -as being effective in combating stress. 3 Though useful, many modern aids to stress reduction are mechanical and reductionistic: they do not address sources of stress whose origin may be existential and only peripherally related to the environment. 
Logotherapy, which assists clients to discover the unique meaning of their individual existence, may have relevance for dealing with certain verified but heretofore inadequately addressed sources of stress. The more seriously one takes Selye's concept of stress as intrinsically related to the person's perception of the stressor, the more one must seek a framework which allows thinking about stress and burnout in terms of individual thought and interpretation. Indeed, several of the major stressors which Cheek identified in correctional officers, such as role conflict and role ambiguity, 7 may be amenable only to a highly personalized approach, such as logotherapy, which acknowledges the centrality of subjective experience. 
That the PIL test correlated so significantly with psychological, physiological, and lifestyle dimensions of Cheek's stress/ burnout survey underscores the potential impact which an existential approach may have on stress research and remediation techniques. Those participants in the Kentucky study with relatively high PIL scores had also correspondingly high health scores. Conversely, those with low PIL scores exhibited correspondingly low health scores. Ko bas a 17 discovered a similar phenomenon in a research study of managers in a Midwestern public utility company. Persons possessing a sense of purpose and active involvement in their personal and vocational lives are less vulnerable to the effects of stressful events and maintain a reservoir ofadaptive resources with which to cope with life_ 11. 1s 
The authors encourage further research into the concepts discussed in this paper. Logotherapy offers a possible treatment approach in corrections and other vocational areas. Indeed, Shaffer argues that Frankl's focus for "purpose in life" is the prerequisite for healthy and adaptive human functioning and "lies at the heart ofany attempt to overcome stress and turn it to our own ends. "27 In the same work he outlined stress/burnout reduction strategies based on logotherapeutic concepts. 
As far as the authors can determine, the present study is the first attempt to address from a research standpoint a definitive relationship between stress and one's perception of meaning in life. It seems ironic that Frankl's concepts were tested in his own personal experiences in a penal setting of another day -the German concentration camps. Even more ironic is the possibility that, in a radically different age and culture, his work may hold the key to create a healthier, more fulfilled existence for the harried keepers of the kept. 
LEONARD E. MILLER is psychologist chief, and STEVEN T. ADWELL is the procedures officer and assistant to the warden at the Luther Luckett Correctional Complex in LaGrange, Kentucky. 
REFERENCES 
I. Adwell, S.T. and B.I. Wolford. The Development and Growth of Standards for Correctional Education. The Journal of Correctional Education, 1983, 34( I), 123-125. 
2. 
American Federation of State, County and Municipal Employees (AFSCME), State Council No. 80, 1981. 

3. 
Burke, R.J. and T. Weir. "Coping with the Stress of Managerial Occupations." In C.L. Cooper and R. Payne (eds.), Current Concerns in Occupational Stress. New York, John Wiley and Sons, 1980. 

4. 
Carruthers. M. "Hazardous Occupations and the Heart." In C.L. Copper and R. Payne (eds.), Current Concerns in Occupational Stress. New York, John Wiley and Sons, 1980. 

5. 
Cheek, F.E. Correctional Officer Stress: How Not to Bring It Home. Corrections Today. 1983, 45(a), 14-20. 

6. 
____ and M.D. Miller. "The Experience of Stress for Correctional Officers." Paper presented to Annual Meeting of the American Academ, of Criminal .I ustice Sciences, Cincinnati, Ohio, 1979. 

7. 
____"Managerial Stress and Corrections Officer Stress." In E. Anderson (ed.), Management ofStress in Corrections. Washington, DC. University Research Corporation, 1979. 

8. 
____ Prisoners of Life: A Study of Occupational Stress Among State Corrections qfficers. Washington, American Federation of State, County and Municipal Employees. 1982. 

9. 
Chesney, M.A. and R.H. Rosenman. "Type-A Behavior in the W,irk Setting." In CL. Cooper and R. Payne (eds.), Current Concerns in Occupational Stre\S. New York, John Wiley and Sons, 1980. Crumbaugh, J.C. and L.T. Maholick. Manual of!nstructionsjiH the Purpose In Life Test. Munster, Indiana, Psychometric Affiliates, 1969. 


II. Frankl, V.E. Man's Searchfor Meaning. Boston, Pocket Books, 1963. 
12. ____ The Will to Meaning: Foundations and Applications ofLogotherapy. New York, New American Library, 1969. 
13. 
Freudenberger, H.J. "Staff Burn-Out." Journal of Social Issues, 1974, 30(1), 159-165. 

14. 
Hamilton, V. "Cognition and Stress: An Information Processing Model." In L. Goldberger and S. Brezwitz (eds.), Handhook of Stress. New York, The Free Press, 1982. 

15. 
Holt, R.R. "Occupational Stress." In L. Goldberger and S. Brezwitz (eds.), Hand!JOok of Stress. New York, The Free Press, 1982. 

16. 
Kelling, FIL. and Pate, T. Job Stress Among Police Officers. HEW Pre-publications No. 7604228, National Institute of Occupational Safety and Health, Cincinnati, Ohio, 1977. 

17. 
Kobasa, S.C., R.R. Hilder and S.R. Maddi. "Who Stays Healthy Under Stress?" Journal of Occupational Medicine, 1979, 21(9), 595-598. 


18. Lazarus, R. Psychological Stress and the Coping Process. New York, McGraw-Hill. 1966. 
19. 
Maddi, S.R. "The Existential Neurosis." Journal of Abnormal Psychology, 1967, 72, 311-325. 

20. 
Mandler, G. "Stress and Thought Processes." In L. Goldberger and S. Bre7witz (eds.), Handbook of Stress. New York, The Free Press, 1982. 

21. 
Miller, L.E. "An Investigation of Age and Sex Differences in Purpose in Life Scores in a Selected Group of Psychiatric In-patients." Unpublished paper, Indiana University, 1982. 

22. 
Pines. A. and E. Aronson. Burnout: From Tedium to Personal Growth. New York. The Free Press, 1981. 

23. 
Sargent, G.A. "The Work Situation." In J.B. Fabry, et al, Logotherapy in Action. New York, Jason Aronson, Inc., 1979. 

24. 
Selye, H.A. A Syndrome Produced by Diverse Nocuous Agents. Nature, 1936, 138.32. 

25. 
____ Stress Without Distress. Work and Health: A Symposium on Stress. West Bend, Indiana, April 14-15, 1980. 

26. 
____ "History and Present Status of the Stress Concept." In L. Goldberger and S. Brezwitz (eds.), Handbook of Stress. New York: The Free Press, 1982. 

27. 
Shaffer, M. Life after Stress. Chicago, Contemporary Books, Inc., 1983. 

28. 
Yalom, l.D. Existemial Psychotherapy. New York, Basic Books, Inc., 1980. 


Growth Stages in Logotherapy 
James E. Lantz 
Logotherapy assumes tharsymptoms are often a signal of the clients' failure to find meaning in their lives, 1.2 creating an existential vacuum which is then filled by the manifestation of symptoms.2 Treatment is directed toward helping the clients find meaning in their lives.1.2,3.4 
This article introduces a number of growth stages originally identified by Quaranta5 as they relate to logotherapy. The logotherapist can use this growthstage model in the complex process oftreatment and in determining the proper timing of logotherapy interventions. The six growth stages identified by Quaranta are awareness, exploration, commitment, skill development, skill refinement, and redirection. 
The Awareness Stage 
In the awareness stage of logotherapy, the therapist helps clients understand that the development and continuation of their symptoms is, at least in part, a result of their failure to find meaning in daily life. In most instances the clients will view the development oftheir symptoms as 'just" a result ofstress, "just" an internal psychological conflict, or "just" a medical or biochemical problem. This "just" view is both reductionistic and a tactic to distance themselves from the need and responsibility to directly reflect upon the spiritual aspects of their existence. This 'Just" defense is understandable. As JaspersJ has noted, the conscious realization of meaninglessness is terrifying and often requires a crisis for people to become truly aware of it. 
Specific treatment the therapist can use in the awareness stage to help clients consciously reflect upon their existential vacuum include: relationship-building activities; the development of trust between therapist and client; pointing out that past medical, psychological and social forms of treatment, while helpful, may have been experienced by the client as "missing something"; providing logotherapy reading material for bibliotherapy assignments; and by simply "planting the logotherapy seed" and waiting for the client's spiritual need to manifest itself later. This last approach is frequently the preferred approach. The spiritual need often manifests itself during a crisis and may result when the client's noetic unconscious responds to the therapist's direct noetic message. 
The ending of the awareness stage is probably the most critical period during logotherapy. As the clients begin to consciously reflect on their feelings of meaninglessness, they more directly experience the pain associated with this meaninglessness. It is a time when the therapist must offer a great deal of support. The therapist must also direct the clients to activities and reflection experiences which help them fill their existential vacuum with a sense of meaning. This occurs by moving into the exploration stage. 
The Exploration Stage 
In the exploration stage the logotherapist engages the clients in noetic experimentation: to discern, through exploration, experiences which can result in the discovery of attitudinal, productive, and experiential values. In this stage the therapist uses direction, suggestion, and encouragement to facilitate the clients' experimentation with their search for meaning. The therapist can use the Socratic dialog, logotherapy reading assignments, self-disclosure, provocative statements, interpretations, structured experiential exercises, and homework assignments to help clients discover specific attitudinal, productive, and experiential values which are personally meaningful to them. 
The therapist is extremely active and directive in the exploration stage~-not to coerce the clients into accepting the therapist's meanings but rather to help them discover their own personal values and meanings which they have repressed. The therapist's activity is designed to free the clients' noetic unconscious. 
Toward the end of the exploration stage, clients will often feel a sense of excitement. They have discovered new possibilities and experiences of meaning. They feel an increased sense of hope. This hope, however, is often short-lived unless client and therapist can move into the commitment and skill-development stages. 
The Commitment Stage 
During the commitment stage of logotherapy the clients, having identified and experienced a few moments of meaning, are asked to decide to either terminate logotherapy or to continue working on a basic and lasting process of realizing meaning. Such a decision cannot be made until the clients have gone through both the awareness and the exploration stage. Without sufficient awareness they will not know that the discovery of meaning is either necessary or desirable. Without exploration they will not know that the discovery of meaning is possible, and they will have little understanding of the directions in which this sea;-ch for meaning could occur. 
Pressing clients for a true commitment to logotherapy before completion of awareness and exploration is like asking a person to appreciate spinach before having tasted it. Only after the completion of awareness and exploration, can clients make an intelligent and informed decision toward either commitment or termination. 
The Skill-Development Stage 
After a commitment for continued treatment, the client and the logotherapist move into the skill-development stage. In this stage they both identify and practice specific methods that clients will find useful in their ongoing search for meaning. The therapist helps clients learn that each emerging moment provides them with an opportunity to discover meaning. The clients use this stage to practice some of the methods of discovery of meaning that have been introduced during the exploration stage. The skill-development stage is a time of repetition, practice, hard work and an increased recognition by the clients that they must replace magical expectations of immediate success with consistent work toward hard-fought logotherapeutic gains. 
The Skill-Refinement Stage 
In this stage clients continue to produce new methods of discovering meaning. It is a continuation ofthe skill-development stage, and the therapist takes a less active role, allowing the clients more opportunities to be in complete charge of refining personal skills in their discovery of meaning. 
The Redirection Stage 
Now the clients are getting ready for termination. In this stage they demonstrate readiness to continue to actively search for and discover meaning without the therapist's assistance. The redirection stage includes celebration. The client and the therapist celebrate the client's growth and then terminate their treatment relationship. The termination is an affirmation, by both therapist and client, of the client's ability to continue to grow. 
JAMES£. LANTZ, Ph.D., is clinical social worker at Harding Hospital, Worthington, Ohio. 
REFERENCES 
l. Fabry, Joseph. lhe Pursuit of Meaning, San Francisco, Harper and Row, 1980. 
2. 
Frankl, Viktor. lhe Will to Meaning, New York, New American Library, 1969. 

3. 
Jaspers, Karl. Way to Wisdom, New Haven, Yale University Press, 1951. 

4. 
Lantz, James. "Meaning in Family Therapy." The International Forum for Logotherapy, 1982, 5: I, 44-46. 

5. 
Quaranta, Joseph. "Conceptual Framework for Career Development Programming" in McCormic, Robert and Wigtil, James, EDS, Guidance/or Planning and Evaluative Career Development. Columbus. Ohio, Department of Education, 1971. 


The Noetic Curative Factor in Group Therapy 
James E. Lantz 

Over the past three years I have been facilitating a psychotherapy group for clients admitted to a short-term, acute-care, psychiatric hospital unit. This open-ended, continuous group meets twice a week. The group participants usually stay in the hospital from four to six weeks. They manifest a variety of psychiatric problems including depression, bipolar illness, schizophrenia, organic brain syndrome, neurotic problems, and adjustment disorder problems. The group has a mixed membership which includes males, females, young adults, elderly adults, poor, rich, and middle-income clients, Caucasians and minorities. 
In spite of the variety of problems, a consistent theme predictably emerges and re-emerges in the group discussions. This "noetic" theme is indicated by such frequent questions as, "What is the meaning of my illness?? "Why do I suffer from this illness?" and "How can I find meaning now that I have a psychiatric illness?" 
Curative Factors in Inpatient Group Psychotherapy 
Yalom has identified the following curative factors in in-patient group psychotherapy: instillation of hope, universality, imparting of information, the corrective recapitulation of the primary family group, the development of socializing techniques, imitative behavior, catharsis, cohesiveness, interpersonal learning, and existential factors. 2 
Although all of these curative factors are programmed to emerge during the process of our group, it has been my experience that group members consistently identify as most important the help the group gives to participants to find meaning in their lives in spite oftheir psychiatric problems. Yalom calls this type of help an existential factor. 2 I am using Frankl's term and call it the "noetic" curative factor. 1 During the past year I have conducted an informal yet objective study to see if the noetic curative factor is an important variable in the ongoing group process. 
Description of the Study 
During this past year we held 102 group meetings, averaging eight members per session. Each group member averages ten group meetings, for a total of 82 participants. Sixty-five of them were asked to rank in order JO group-therapy curative factors. Each client was given ten index cards. Each card contained a brief description of one curative factor, and the clients were asked to arrange the cards from 1 to 10, with number 1 being the curative factor the client found most 
helpful, and number JO the factor least helpful. Seventeen group participants 
were unable to rank the curative factors because of logistic variables. Table I describes the curative factors and table 2 shows the rankings provided by members of the group. 
Significant Results 
The noetic curative factor was the one chosen most often as being the most important. It was picked 42 times as number I, 2, or 3. Other curative factors frequently picked among the first three were: universality (34 times), cohesiveness (30 times) and instillation of hope (28 times). 
In my view, universality, cohesiveness, and instillation of hope are curative factors which also have an existential or noetic characteristic. In the inpatient psychotherapy group described in this paper, the search for meaning was a powerful and useful process as viewed from the group members' perspective. 
JAMES E. LANTZ, Ph.D., is a clinical social worker at Harding Hospital, Worthington, Ohio. 
I. Frankl, V. The Will to Meaning, New York, World Publishing Co.. 1969. 
2. Yalom, I. Inpatient Group Psycho1herapy, New York, Basic Books Inc., 1983. 
Table I. Curative Factor Descriptions 
Instillation of Hope: "The group helped me find hope." 
Universality: "The group taught me that other people have problems that are similar to mine and that I am not alone." Information: "The group gave me useful information about my problems and 
how to solve them." 
Corrective Recapitulation of the Primary Family Group: "The group helped me understand my feelings about my family of origin." Socialization: "The group helped me learn more about how to socialize with 
people." 
Imitative Behavior: "Other group members showed me some new ways of solving problems." Catharsis: "The group helped me express some buried feelings." Cohesiveness: "The group helped me feel that I was accepted." Interpersonal Learning: "The group helped me change some of the ways I 
interact with other people." Noetic Factors: 'The group helped me find meaning in my life." 
Table 2. Client Rankings of Curative Factors 
CURATIVE FACTOR RANKING BY CLIENTS (65 CLIENTS) 
#I #2 #3 #4 through # IO (65) 
Instillation of hope 3 .., ! 18 37 (65) 
Universality I I 13 10 3I (65) Information 2 61 (65) 
Family Recapitulation 4 2 3 56 (65) 
Socialization 6 "l 8 49 (65)
L 
Imitative Behavior 0 10 0 55 (65) 
Catharsis 0 0 64 (65) 
Cohesiveness 5 15 IO 35 (65) 
Interpersonal Learning 7 6 8 44 (65) 
Noetic Factors 27 8 7 23 (65) 
(Total) (65) (65) (65) (455) (650) 
The International Forum for 
LOGOTHERAPY 
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