SOURCE_DOCUMENTS/journal_016_2.txt

Volume 16, Number 2 Autumn 1993 
The International Forum for Logorherapy, 1994, 17, 1.7_ 
THE ECCE HOMO TECHNIQUE: A SPECIAL CASE OF DEREFLECTION 
James C. Crumbaugh end R011em11ry Henrion 
The Ecce Homo technique was originated by Frankl arid Olustrated in the case of Frau Anastasia Kotek.' It is a special case of dereflection to atmudjnal values in a suffering person-a spedal case because the client's assets are specifically pointed out with encouragement In specific ways to use assets to actualize personal attitudinal values and be an "exemplary sufferer.· 
Frankl did not name the Ecce Homo technique as a special procedure. It has not been formalized previously-the thrust of the present paper Is to do so. 
The technique's bask framework starts with explora~oo of the client's suffering, jnduding the history behind It plus the client's feelings associated with It. Next, a clear picture of the client's assets and liabiltties Is formulated, with emphasis upon not only the uniqueness of the suffering but also the uniqueness of the opportunity to use assets to respond to such suffering "as an exemplary sufferer.• Then potential anlludes (anltudlnal values) toward the suffering are explored, including avenues of behavior through which atmudlnal values may be expressed toward the suffering. Finally, the cljent '5 reinforced by encouragement for emitting behaviors fulfilling the attltudjnal values. The key to theEcce homo technnlque lies In bulldlng sell-<!S!eem by demonstration that the individual has achkwed unique personal meaning as somebody through becoming an examplary sufferer 
Frankl's Prototypical Cesa 
The procedure can best be made clear by a short recapltulation of Frankt's case of Frau Anastasia' This lonely, old woman had been stricken with a tmmlnal Ulness, and she was angry and depressed. She told Professor Frankl in effect, "Why shouldn't I be de)Xessocl? Hme I am in my OO's w~h nothing to show for my life. I was always going to amount to something, but I never even got around to getting married All I ever did was domestic work, and now I am about to die. How can my Ina now have any meaning?" 
Frankl expressed understanding of her feelings, and he explored w~h her the jobs she had held. She had occupied Important poslUons of trust as a domestic for several leading famllles who l',ad treated her almost as one of them. She had travelled with them, gone to special events with them, met 
' 
many famous people arourvj them. So It was clear she hadnl failed as badly as she thought-which she now admitted with a smile. But then she added gloomily, "I have no luture-nothjng to look forward to." 
Here Frankl explored her attltudinal values••medlcal science could not change her situation arv;J she had only two ways to go: either on down the drain In despair. or out with a bang Instead of a whimper. Would It make a difference which way? Yes, because with a positive attitude there was still something Important that she could accomplish. something that she had ovenooked. The hospltal staff had noticed that she was a leader among the lennlnal pallents. and that In spite of her own desperation she always found lime and strength to comfort others. "Frau Anastasla." Frankl told her. "you have already achieved a remarkable feat. You have made the best of an otherwise Impossible situation by making your lime courTI In the helping of others. Pe,haps the purpose for which you were put on this Earth in the first place was just so you could do what you are now doing on the ward." 
She was surprised, but fascinated by this thought. Frankl followed it up. "You are now achieving something which few people ever get a chance to do. I congratulate you and commerv;J your example to this cJass of medjcal students. Ecce Homo! (Behold the human be;ng). 
The medical students burst into applause, and the episode so motivated Frau Anastasia that she faced her flnal days wlthmn depression or anger. Her last words were. '"Yes, my lffe has meaning, which Professor Frankl showed me." 
This special case of derellecllon had worked well for her. The arousal of a sense of meaning and purpose In an otherwise hopeless situation produced exemplary suffering and made this suffering morn tolerable arv;J worthwhie. 
An Example lrom Lukas 
Lukas applied this method with a client trapped in a bad marr~ge.' The client came to Lukas to complain. Then a bad aUlomoblle accidool lelt his w<fe with extensive cerebral damage, partially paralyzed. The cliem now fell both depression and gull over having complainac! about many tnvial things. Lukas countered thBfapellllcally by showing him to be an exemplary sufferer. He had placed his wife in a good nursing home; he visited her regulaMy: and he did all he could to care for her. Lukas noted that this was an extraordinary achlevernem: He easily could have neglected hor and thus have taken revenge, but he did not. This represented true inner.greatness that he never would have discovered had the tragk accident not occurred. 
Comments about the Ecce Homo Technique 
The writers of this paper consider some of their most successful cases to have been those in which the clients were helped to become aware of the meaning of their suffering and of their role as exemplary sufferers. This created an awareness of new meaning and purpose in the clients' unique situation. 
One key to success, embedded throughout the technique, is getting the clients to feel good about themselves through pointing out assets and thus building self-confidence and self-esteem. This enables the dereflection to occur in spite of whatever limitations the clients have suffered. It enables them to utilize potentialities, and to recognize success in themselves even if the world does not. 
The Ecce Homo technique accomplishes this by stimulating new insight into old habits of escape and defense. That leads to reframing the total situation and yields a new perception of the self in relation to the situation. New action results from the new perception. 
The overall picture as applied in logotherapy is one of utilizing attitudinal values to dereflect; to determine action that circumvents individual limitations and magnifies remaining assets. This elucidates new meanings in an otherwise hopeless-seeming existence, and enables the clients to go on courageously and hopefully in a life that has become seemingly unviable. 
The specific application of these generic principles requires the logotherapist's creative innovations in leading the clients to reframe their situations in the direction of hope, optimism, and self-confidence in order to go on effectively in spite of past mistakes and failures. It enables the clients to save their careers, health, family, loved ones, or a specific job through their own efforts. It enables them not to be self-satisfied only when anxiety is reduced and a homeostasis is established; and not to grimly accept a bad situation after having learned how it came about; and not to remain dependent on the therapist over many years. 
Some clients respond to the Ecce Homo technique within a brief period, possibly because of their strong desire to change. They quickly become aware that they are the only ones who can fully and meaningfully complete the specific mission in their lives which constitutes their uniqueness. The therapist also will observe a sense of relief and an increase of self-esteem--two feelings that must be sustained throughout the therapy program. If these clients do not receive emotional support and consentual validation, the motivational level may decrease rapidly. Thus, support and validation need to be continued by the logotherapist until the clients have internalized the attitudinal changes. 
Recent Case Examples 
Mike 
Mike was in the Navy for 16 years before sustaining a brain injury along with skeletal fractures In an automobile accident. He had been considered handsome, with good physique, effervescent personality, status in an elite group, and living a challenging and sometimes dangerous existence. Mike's two brothers also had much status in society. The three men had been competitive during their school and adolescent years. Prior to his accident, Mike felt that he had been "on target" in being successful and having travelled around the world twice by the time he was 30 years old. 
He sustained his injuries when his automobile hydroplaned, after impacting a pool of water on the expressway, and crashed into a cement wall. Mike had to be extracted from the vehicle with the "Jaws of Life." He was comatose and placed in the intensive care unit. Recovering consciousness two weeks later, he was afraid that his career had come to a close. This was devastating to him, and he experienced the first stages of the grieving process: disbelief, shock, denial. 
As soon as Mike was physically capable, he began brain-injury rehabilitation. He learned to read and write again, how to circumvent his shortterm memory deficit by taking copious notes, and once again the basic skills in daily problem solving. 
Mike's wife divorced him. A girlfriend remained with him for a brief period, and then left. But his immediate family provided emotional support. 
Mike saw a therapist in the outpatient clinic for depression. The therapist felt that Mike would benefit from the logoanalysis program at the Veterans Affairs outpatient clinic where logotherapy is applied by the second writer of this paper. 
Mike was very much a suffering person--he was feeling hopeless, confused, and had no sense of direction for a successful future. He was evaluated as a good candidate for the Ecce Homo technique. His unique achievement in conquering the physical handicap that fate had dealt him was emphasized, and that which he still had the potential to accomplish was noted. Ego-strength and self-esteem soon increased. He and some of his peers began to socialize outside of the logoanalysis group, and he established daily goals. His attitude became more positive. 
Mike has now completed the program and has been evaluated for a volunteer position at the Vocational Rehabilitation agency. His next goal is to find a girl with whom he feels he can develop a meaningful relationship, to marry and settle down to being a husband and, hopefully, a father. He wants to put the glamorous, superficial, fast-track life aside now. 
Regarding attitudinal values, does Mike think that this tragic fate had to occur before he could encounter the need for a deeper, more meaningful life? He responds in the affirmative. He feels that the future continues to be a challenge, but the emotional support and authentic friendships he is experiencing are greater rewards than he ever dreamed of having. He knows the difference between conditional and unconditional love, and he feels that no one else can discover for him the real meaning of this love. Once bored and empty, he now is enthusiastic about facing the uncertainty of the future. He now is an exemplary sufferer, sensing his capacity to use his unique experiences in a new way--to find the unique meanings and achieve the unique goals that have become possible only because he did receive the fateful blows that were dealt him. 
Sam 
Sam is another example of a person to whom the Ecce Homo method of dereflection was applied. He sustained a brain injury 16 years earlier while on Army maneuvers. He was "DOA" (dead on arrival) at the emergency room of the Army hospital. But he was resuscitated and rehabilitated and later discharged from the military. He first went to live with his parents. Then he was married and divorced three times. He entered the logoanalysis program about the same time as Mike, and they had similar experiences during their rehabilitative process and developed a friendship. They both had short-term memory deficits, spoke with some slurred speech, and walked with a specific gait. Individuals not knowing these men mistook their behavior for evidence of being intoxicated--this served as a major image problem for both men. They felt that while the opposite sex would be pleasant to them, women were not interested in developing a serious relationship with either. 
Sam's attitude was positive until he began to feel hopeless about his future. He wanted to be happily married and have a family. At times he became depressed and began to drink and take illegal street drugs, which left him with visual and auditory hallucinations. 
While attending the logoanalysis program, Sam developed a conscious awareness that being a survivor of a major accident is itself an accomplishment. The major thrust of the Ecce Homo technique was to guide him toward this awareness. He said that he would prove the doctors wrong by learning to walk and speak articulately after they had told his mother that he would not be capable of doing either. He was determined to be a "whole man" again, and he said only a few 19-year olds (his age at the time of the accident) would accept this kind of a challenge. 
Sam worked hard and won. Presently, he has a volunteer job in putting together a monthly newsletter at a local hospital for the Volunteer Service. He has a girlfriend; they plan to get married. Sam also received emotional support and developed authentic friendships in the logoanalysis program. He learned to socialize with others who have similar values. 
Sam, like Mike, learned the difference between conditional and unconditional love. He reported to the therapist that he felt he was gaining an understanding of the meaning and fulfillment of his life; and that obstacles can be stepping stones to higher values. 
Sam has the attitude of being a •survivor," although this is not easy at times. He feels he will have a valuable future in assisting others who are physically handicapped. Thus he has identified with Frankl's Ecce Homo picture of the unique accomplishment in turning a fateful blow to advantage. 
Al 
Al had cardiac problems, crushed vertebrae, and hypertension. He was having difficulty accepting his declining health. His major symptoms were feeling victimized and depressed. Al had a traumatic encounter with an official from the state car licensing bureau, and he became so hostile that he almost assaulted the official before his wife intervened. He later said, "That is not like me! One day I was healthy and young, and before I knew it I became old and sick. I never thought about this happening to me.· 
Through the logotherapeutic process Al became consciously aware that he could still be productive in truck-farming and working for his son who owned an upholstery business. He gained the feeling that his unique fateful experiences represented a unique opening for attaining new goals that otherwise would not have been possible. He could work at his own pace and have an adequate income. He also developed an awareness that he was dehumanized by the licensing official who spoke condescendingly to him. He became aware of his uniqueness as a human being, and he became determined not to allow anyone to take that from him. He recognized his belief in traditional values and decided he would like to be a role model for his grandchildren. 
Two days following his last session, Al encountered a situation similar to that which he had experienced with the licensing official, and he coped with this one very well. He was proud of this accomplishment. He chose to remain in treatment for extra weeks because he felt that he learned something new every time he came to a session. When he completed the program, he was invited to join the advanced logotherapy group. 
Conclusions about the Case Examples 
Each of these three recent cases exemplifies becoming aware of being the only one capable of action enabling the individual to be the best that one can be. Each, because of an accident, needed to pursue a different than originally expected route in arriving at this goal. 
Individuals who have been successful in logoanalysis have all developed at least some degree of conscious awareness that they are the only ones who can act on their own behalf to accomplish what they have dreamed of, or even to go beyond. They have just needed some assistance in discovering the appropriate path and in finding new meanings in old habits and experiences. The Ecce Homo technique has in these cases been a key to this assistance. 
JAMES C. CRUMBAUGH, PH.D. [140 Balmoral Avenue, Biloxi, Mississippi 39531 U.S.A.) is a dip/ornate and fellow of the Viktor Frankl Institute of Logotherapy. Senior author of the Purpose-In-Life (PIL) test, he has been a clinical and research psychologist and a disciple of Frankl for nearly 35 years. Presently retired from the Department of Veterans Affairs Medical Center in Gulfport, Mississippi, he continues to write on logotherapy and is now working on his fifth book. 
ROSEMARY HENRION, M.S.N., M.ED., R.N., dip/ornate in /ogotherapy, is a clinical nurse specialist practicing /ogotherapy with the Department of Veteran's Affairs [312 Kenmore Road, Pensacola, Florida 32503 U.S.A.]. Ms. Henrion has been the primary therapist for the logotherpay program since 1980. She has authored publications on logotherapy and presently is coauthoring a text with Dr. Crumbaugh. The present paper reflects the authors' personal views and in no way represents the official view of the Department of Veterans Affairs or the federal government. 
References 
1. 
Frankl, V. E. (1965). Fragments from the logotherapeutic treatment of four cases. In A. Burton (Ed.) Modern Psychotherapeutic Practice. Palo Alto: Science and Behavior Books. 

2. 
Lukas, E. (1992). Meaning and goals in the chronically ill. International Forum for Logotherapy, 15, 90-98. 


The International Forum for Logotherapy, 1994, 17, 8-13. 
THE ELEMENT OF SURPRISE IN THE LOGOTHERAPEUTIC TREATMENT OF ADOLESCENTS 
Paul A. Welter 
Viktor Frankl tells of two suicidal men, fellow prisoners in a concentration camp, who "had nothing more to expect from life."3'pg.ioo-ioi When Frankl 
confronted them with a surprising, new, self-transcendent thought, "What does life still expect of you?" they saw a new horizon. They were shocked by the offer of a moral choice to consider others' needs. 
Elisabeth Lukas startled a clinically depressed client: "You stand among the flowers and water the weeds," she told the patient. 'That's exactly what I do," decided the patient.6·P· 136 Dr. Lukas's surprising observation and metaphor broke through denial and disarmed the patient. 
Joe Fabry speaks of challenge. Clients often are surprised by a counselor who sometimes challenges them rather than uninterruptedly soothing them. Fabry points out that 'The challenging is done with empathy.''2•P•136 
Thus, the element of surprise in logotherapy has a long history. It is not the surprise that brings about healing and growth, but rather the client's attitude shift toward meaning does this. Surprise is the "attention getter" or "invitation" rather than the substantive component in treatment. 
We know it often is difficult for adults to get the attention of adolescents. The present article suggests a number of methods that logotherapists may employ utilizing the element of surprise to gain adolescents' attention and involvement, thus inviting them to healing and growth. 
Action-Based Methods 
John Gatto, New York City's Teacher of the Year in 1990, tells of a five-year program in which he had every adolescent in his school give 320 hours a year of community service.5 Many of these youth came back years later to say that the experience had changed their lives and taught them to rethink their goals and values. The community service surprised these adolescents and caused them to answer the question, "What does life expect of me?". This self-transcendent activity changed their lives in a positive way. It may have kept many of them from pursuing a life of thefts and assaults. 
There is a hopeful sign that this requirement for community service may be spreading. In 1992 Maryland became the first state in the U.S.A. to require community service for high school graduation. 
At the University of Nebraska at Kearney, we require our sophomores in teacher education to do 45 hours of community service. A 19-year-old student in my class in teacher education was somewhat detached from the entire teacher education venture until he went out to help in a kindergarten group. Ed was assigned to work with the most aggressive boy in the group. During his first day, this 5-year-old hit Ed squarely in the abdomen with his fist. From that point on Ed was puzzled, and even alarmed, but he was no longer detached from the teacher education process. He even initiated several dialogues with me about ways he might intervene. 
However, Ed spontaneously invented his own surprise response when, after about two weeks, the kindergartner took aim at him again. Ed put the kindergartner in a bear hug and held him for a length of time. The result of this unusual intervention was that Ed got the student's attention just as earlier the kindergartner had gotten Ed's attention. They then went through a process of tolerating each other, beginning to like each other, and finally ending the semester as friends. The child became less aggressive, and Ed became more motivated in teacher education, probably because it had more meaning for him. He found that he could respond creatively to a surprising and difficult challenge. He was actually able to respond to a crisis in a way that left another person and himself better human beings. 
Combination Action-Language Based Methods Socratic Dialogue in Small Groups 
A Socratic dialogue makes individuals in small groups move on to action. Participants often come into groups expecting just an exchange of words, and they are surprised when action ensues. The Socratic dialogue in small groups goes beyond self-discovery--on to action issues of choice, risk, responsibility, and commitment. 
In one of my counseling groups in a junior-high school, a girl, whose family moved often, talked about the pain she endured when transferring into a new school and walking down the hail or into the cafeteria alone. We talked in the group about our responsibility to lessen human suffering. Before the group session was over, the members committed themselves to action. They committed themselves to notice new students and get acquainted with them so they would not have to walk alone. 
WrHing/Journaling /Drawing 
Self-distancing is an Important first step in logotherapy. Sometimes it is difficult to help an adolescent self-distance in a regular conversation. In those Instances, we may achieve self-distancing by requesting the creative act of writing, Journaling, drawing, or painting. It is often a surprise to the client to be asked to create outside of the treatment session, rather than to just talk within the treatment session. 
A bright but depressed high-school senior came to see me, in part because he found the pressure of being gifted almost more than he could bear in his school life. As we talked he got the idea of writing an article for a teachers' magazine that would help teachers understand the pressures of giftedness. In writing the article, he synthesized his own experiences and, as a result, found that healing took place. Once he employed his creativity to get the story outside himself, he could understand it. 
I ask each depressed person I work with, adolescents included, what they are creating. The question usually comes as a surprise to the client. Most clients expect the therapist to talk more about "psychological" factors. 
I think part of the genius of Frankl is his emphasis, not just on tasks, but on creative tasks. As J. E. Bruner has noted, surprise is an integral part of any creative act.1 
Most of my depressed clients say that they used to create but do not have time anymore, or for some other reason the creativity has shut down. I ask them to create something (whether it is writing down some of their thoughts, doing some woodwork, or drawing something) and to bring it with them to the next counseling session. This is where the action is combined with language. We discuss what they bring back in terms of the meaning that the created object, or the process of creating, or both, have for the client. Most of these discussions have considerable impact for clients in redirecting their future. 
Language-Based Methods 
Maieutic Questions 
Michelangelo said of his work as a sculptor, "I see the angel in the marble and I just chisel until I set him free." In a similar way, logotherapists need to see the potentials of a client to ask effective questions. But, as Frankl said, we also must possess the ability to ask "questions in the frame of a maieutic dialogue In the Socratic sense."4'p.5S Maieutic is defined as: 'To act as a midwife. Relating to that aspect of the Socratic method that aids an individual in the formulation of latent concepts."8'P·717 One of Frankl's greatest gifts to therapists and to clients is that he has refined this maieutic aspect of Socratic questions. 
Eart Wilson mentioned in a 1988 workshop that he has used the following questions with adolescents: "How old do you think you will be before you can talk calmly with your parents when you disagree with them?" "Do you yell at your friends when you disagree with them? Do you want to hurt them or do you want them to understand you?" These questions are surprising and they help adolescents look at the issues in a different way than they had been viewing them. Other questions that might be asked include: "If you were supposed to have learned something from your life up to this point, what would the lesson be?" "What is a challenge you have before you right now?" "As you look back on your life, what were the moments when you were most yourself?" "How would your good friends answer me if I were to ask them about your special, unique strengths?" "How do you find the courage to do what you know you need to do?". 
It is important when talking with adolescents to ask only a few well-chosen questions, and to follow each question with ''wait time." The wait time shows respect for the adolescent and allows thought-processing time. Whenever possible, questions should be designed to evoke new attitudes. 
A high-school senior was involved in witchcraft. She had suffered many losses in her family. She felt powerless to make a difference with her family. I asked, "Because you cannot control the destiny of your family, will you also give up the right and even the obligation to be responsible for your own destiny?" 
Metaphors 
A high-school senior decided to get married. She asked what I thought of her decision. I replied, 'There is an old saying that if you crawl from one nest to another, you will never learn to fly." The metaphor had such surprising clarity for her that she was angry with me for two weeks, so we had to work that out. I think the metaphor was useful to her in that it caused her to give more thought to her decision. Hidden beneath the metaphor were the logotherapeutic concepts of freedom and responsible choice. This "underground" message of metaphors often bypasses resistance so that adolescents are able to receive the communication, even if at first they may not agree with it. 
One of my graduate students has given me a metaphor that is useful in working with adolescents who are moving too fast. A therapist can draw stairsteps and note that many stairs have a landing about half-way up. Most of us need a landing now and then as we ascend the stairs of life. A question that can be asked a fast-moving adolescent is, "You have made many decisions; you have climbed many steps. You still have many more to go; but now you are on a landing. You have a little time to rest, and think, and choose. What have you learned from the past flight, and what choices do you need to make before you climb the next set of stairs?" 
Stories 
Adolescents do not expect counselors to tell them stories, so just the telling of a story Is a surprise. Many times people respond to stories differently than I anticipate. I told a college student who had bulimia the story of The Robber Knight.6·P·75 This story tells of a knight who terrorized the countryside. One day, he fell from his horse. He grabbed the horse's tail, and he bobbed along through the village behind the horse. The people laughed at him, and as they did so they found their fear disappeared and they were able to resist him. When I asked, "What does this story mean to you?" the student replied, "It means that I should stop running from my bulimia, and turn around and face it." This was an important step on her way to overcoming bulimia. 
Another story that I tell adolescents is Herman Melville's Billy Budd.7 I tell the story to persons who have "lost their voices," and to people who are violent. Billy Budd was an innocent young sailor who loved his life except for two obstacles: one was his embarrassing stuttering, and the other was a chief petty officer who made Billy miserable. This petty officer lied to the captain about what Billy had done, and Billy was brought up for trial. During the trial the officer falsely accused Billy Budd. This made Billy so angry and afraid that he was unable to talk at all. Then, because this present stress recapitulated a lifetime of frustration in trying to speak clearly, and because of the falsity of the chief petty officer's accusations, Billy hit the officer. He hit him so hard that he killed him. When he was tried for murder, Billy was able to talk. He said 
that he knew what he had done was wrong, but that if he had been able to talk he would have not hit the officer. 
Clients draw various kinds of inferences from this story. One inference is that we often cannot find our voice when it comes to defending ourselves. However, when Billy Budd no longer worried about defending himself (he knew he would be executed), he was then able to defend the truth. We are more obligated to defend the truth than to defend ourselves. A second inference is that if we can find our voices and say what we need to say, we will be much less likely to speak with our fists or weapons. 
I ask violent clients, "When did you lose your voice and start to use your fists instead?" One reported losing his voice at five years of age when his father beat him for telling the truth. The next step was to help him with the arduous, creative task of finding and using his own responsible voice again. 
Conclusion 
Logotherapists who design interventions that surprise adolescents do so to get a hearing. A fringe benefit is that the therapists may find their work more interesting. Since adolescents surprise adults many times, it can be a pleasant and interesting experience to return the favor. As we surprise our clients we stand firmly in the tradition of Viktor Frankl, whose patients have been consistently surprised and helped by his life and actions, by his questions, metaphors, and stories, and by his deep regard for their dignity. 
PAUL R. WELTER, ED.D. [P. 0. Box 235, Kearney, Nebraska 68848-0235 U.S.A.] is a counseling psychologist and dip/ornate in logotherapy who currently writes and leads seminars. He has authored six books. 
References 
1. 
Bruner, J. E. (1962). The conditions of creativity. In H. E. Gruber, G. Terrell, & M. Wertheimer (Eds.), Contemporary approaches to creative thinking. NY: Atherton. 

2. 
Fabry. J. B. (1968). The pursuit of meaning. San Francisco: Harper & Row. 

3. 
Frankl, V. E. (1959). Man's search for meaning. Boston: Simon & Schuster. 

4. 
Frankl, V. E. (1967). Psychotherapy and existentialism. NY: Simon & Schuster. 

5. 
Gatto, J. (1991, Sept./Oct.). Why schools don't educate. The family net-worker, pp. 55-59. 

6. 
Lukas, E. S. (1984). Meaningful living. Berkeley: Institute of Logotherapy. 

7. 
Melville, H. (1965). Billy Budd. NY: Heritage. 


8. Webster's II new riverside dictionary. (1984). Boston: Houghton Mifflin. 
The International Forum for Logotherapy, 1994, 17, 14-19. 
FRANKLIAN TREATMENT WITH TRAUMATIZED FAMILIES 
Jim Lantz and Jan Lantz 
Frankllan treatment with traumatized families uses network interventions to increase meaning opportunities in the family's social environment.15'16 When the traumatized family is Isolated because it is causing anxiety and discomfort in the social network, the therapist must then help the family develop a new support network that will understand the impact of trauma upon the family. The therapist teaches the family new skills (interactional, communication, and problem-solving) so the family can make better use of existing meaning possibilities.1•11 
Through existential reflection (Socratic dialogue) the therapist of traumatized families uses questions, comments, empathy, interpretations, and sincere personal Interest to help the family bring repressed meanings and 
11 1416
meaning potentials out of the unconscious into family awareness. ' ' Repression keeps the traumatized family from directly experiencing the pain.4'9' 16 However, repression also keeps the family from seeing meaning 
28 14
potentials embedded in the experience of the trauma. ' ' The recovery of meanings embedded in the trauma can be extremely painful for the family,9 but can trigger powerful treatment results,7'14'22 especially in conjoint interviews of family members or in group treatments.21 Remembering traumas without the recovery of meaning potentials is dangerous. The traumatized family will resist such a treatment approach until its members are confident that the therapist is capable of helping the family, will not proceed too fast, believes in the method, and shares the treatment rationale. 13 
Clinical Examples 
The Smith Family 
Mrs. Smith served as an Army emergency surgery nurse during the Vietnam war, working long hours to save the lives of severely wounded American soldiers. She sought counseling in 1985. After unsuccessful breast-cancer surgery and chemotherapy, her prognosis was terminal. She reported having flashbacks to dying soldiers she had worked on in Vietnam. 
Mrs. Smith had adjusted to civilian life since returning from Vietnam. She had never talked about Vietnam because no one wanted to listen. Mr. Smith reported that he tried to talk with his wife about her experiences minimally because he wasn't sure it was a good idea to stir things up. 
Thus, 33-year-old Mrs. Smith, who had been exposed to the gore of Vietnam, had been unable to speak about her experiences when she came home. Fifteen years later, facing death herself, she started to get in touch with her Vietnam past. Her flashbacks served to make her think about her war experiences before she died. 
Treatment focused on existential reflection to help Mrs. Smith and her family talk out her memories, help her grieve the young men she lost in Vietnam, and, in her daughter's words, "to help us honor Mom for the job she did in Vietnam. ¦ The therapist helped the Smith family realize that sharing Mrs. Smith's past could be a meaningful way for the children to remember their mother with pride to help them face the conflicts of adolescence without their mother. 
The Jones Family 
Mrs. Jones requested treatment for anxiety-causing memories and images when drifting off to sleep. She had begun to drink to help her fall asleep. 
The images started after her daughter's seventh birthday. At that time, Mrs. Jones started to have flashback images of her own seventh year of life, when she had been raped repeatedly by a neighbor who threatened to kill her if she told her parents. After a year the neighbor moved away. She told her mother who, however, did nothing. Mrs. Jones then repressed her memories of terror until her own daughter turned seven. 
Treatment focused upon Mrs. Jones remembering and talking with her husband about her year of terror and then exploring why no one had helped her as a child. With the therapist's support, Mrs. Jones invited her mother and father into family treatment to tell them what she remembered and find out why they ignored what had happened to her. Mrs. Jones was surprised to discover considerable support from her husband and her parents. Her parents had not known what to do and had felt guilty for years. Mr. and Mrs. Jones reported that one of the most helpful elements of the treatment was the way the therapist helped them develop a plan to find meaning in Mrs. Jones' memories through volunteer work at a child-abuse prevention agency. 
Stages In Treatment 
Franklian treatment with traumatized families is not a short-term approach. It includes five stages and considerable time. In the Smith family, treatment lasted from 3 months prior to Mrs. Smith's death to 7 months following her death. The Jones' treatment lasted almost 3 years. 
Stage One: Establishing the Treatment System The therapist must develop the family's trust and commitment to the 
13 13
treatment process. '' During this initial period the family tests whether the therapist can manage the specific memories of terror in a safe and empathic way. This testing remains largely outside of the family's conscious awareness. It occurs In different ways, often by testing whether the therapist can handle comfortably a show of anger by one of the family members.9 The family determines, often in a subjective way, whether the therapist will be able to work with the family's specific trauma. The therapist should not expect to be able to work with every traumatized family and should respect the family's desire to work with a different therapist without blaming the members and viewing their resistance as pathological.9010•14 
Stage Two: Remembering Terror 
At this stage the therapist helps the appropriate member to remember the specific details of the family trauma and to realize that the entire family has been its victim.3'9 The members are encouraged to reflect upon how the 
9 14 15
trauma has disrupted family meaning opportunities and awareness. ' ' This is done by specific questions, or at times through the use of drawing and art.20 Family members are encouraged to tell each other the story of the trauma as they remember it, including memories of sight, sound, taste, smell, and tactile experiences and reactions. The more details that can be remembered and discussed, the greater is the possibility that the family will be able to discover meaning potentials during stage three. The therapist must be concerned about protecting the clients from becoming overwhelmed during stages two and three. 
Stage Three: Recovering Meaning in Trauma 
This stage is difficult to separate from stage two. Emphasis shifts to discovering meaning opportunities embedded in the memories of terror. Without such discovery the traumatized family will be unable to fully recover. 7'9 The victims of terror can recover most fully when they find a way to make use of the self-transcendent meaning opportunities that specifically evolve out of 
578 7 18
the victim's personal experience. 4' ' ' Frankl,5' Lifton,17' Shatan,21 and others have attested how survivors in concentration camps, in Vietnam, and Hiroshima have discovered their human potential when they found their unique, self-transcending way of giving to the world. 
Another way for the traumatized family to find meaning in their memories of terror is to help them understand a specific symptom or symptom cluster. Victims of terror may develop unusual symptoms that they experience as "crazy.· For example, Mrs. Jones had always felt "nuts" because being photographed would "drive me up the wall.· This photophobia made sense to her after she remembered that her rapist would photograph her before he raped her. She felt a great sense of relief when she discovered that there was a good reason for her photo anxiety. 
Stage Four: Making Use of Meaning Potentials 
Making use of trauma is most effective when it is done through self-transcendence.4'7'8 Such giving to the world may occur in a self-transcendent relationship with nature, an important cause, or another 
5678
human being.4' ' ' ' Frankl believes that self-transcendent giving is the only effective way of transforming survivor guilt into survivor responsibility. 
Lifton consistently points out that survivors of near-death experiences have two major responses: they can go "numb" and repress the experience and its associated anxiety at the expense of a rich life in the here and now, or they can fully experience death anxiety, and let this anxiety evolve into creativity 
18 19
and/or advocacy. 17' ' Logotherapists would label this response of creativity and advocacy as self-transcendent giving to the world. In Franklian treatment it is the therapist's task to help the traumatized family find their own specific ways to transform terror into meaning through 
15 16
creative activities and activities of advocacy.14' ' An example: Mr. James served in Vietnam. When he returned home, he married his high-school girlfriend, graduated from college, and had a son. Mr. James had no problems adjusting to life until 15 years after his return, when he had flashbacks and intrusive memories about his time in Vietnam. Existential reflection helped him remember and tell his wife about "killing a Viet Cong soldier who was about the same age as our son" and about his platoon finding a peasant village in a free fire zone that was "destroyed by American bombing." Mr. and Mrs. James used the memories of terror as reasons to become better parents and to become active volunteers at a shelter for the homeless in honor of the dead young soldier and in memory of the destroyed village. 
Stage Five: Termination and Celebration 
At this stage the traumatized family is helped to establish and maintain a natural family network of support and meaning. This final stage includes 
9 10 13
celebrating the changes the family has made during treatment. •• 
Termination and celebration should not take place until the traumatized family has had adequate time to accept and integrate the new family meanings.10 Premature termination and celebration can result in recurrence of the symptoms.9' 10 An effective method for the family and therapist to judge whether the family is ready to terminate treatment is to observe the emotional quality of the pre-termination celebration. Such celebrations are planned by the family and therapist, and often include food, coffee, and soft drinks. It should be emotional and spontaneous, and include a mixture of joy and sadness. It should have an ambiance of excitement and regret. All members should be emotionally involved.9' 10 
If the pre-termination celebration is experienced by either the traumatized family or the therapist as a forced and hollow occasion, termination is probably premature.10 In such a situation, the therapist should talk openly about these concerns with the family. An informed and mutual decision about termination or the continuation of treatment can then be reached. 
JIM LANTZ, PH.D. and JAN LANTZ, M.S.W. (6641 High Street, Suite 200, Worthington, Ohio 43085 U.S.A.] are co-directors of Lantz and Lantz Counseling Associates and faculty members at The Ohio State University, College of Social Work. 
References 
1
. Andrews, E. ( 197 4). The emotionally disturbed family. NY: Jason Aronson. 

2. 
Crumbaugh, J., & Maholick, L. (1964). An experimental study in existentialism. Journal of Clinical Psychology, 20, 200-207. 

3. 
Figley, C. (1989). Helping traumatized families. San Francisco: Jossey /Bass. 

4. 
Frankl, V. {1953). Logos and existence in psychotherapy. American Journal of Psychotherapy, 7, 8-155. 

5. 
Frankl, V. (1954). Group psychotherapeutic experiences in a concentration camp. Group Psychotherapy, 7, 81-90. 

6. 
Frankl, V. (1958). On logotherapy and existential analysis. American Journal of Psychoanalysis, 18, 28-37. 

7. 
Frankl, V. (1959). Man's search for meaning. NY: Simon & Schuster. 

8. 
Frankl, V. (1983). Theorie and therapie der neurosen. Munich: Reinhard. 

9. 
Lantz, J. (1974, March). Working with the Vietnam veteran family. Invited lecture at The Ohio State University Medical School, Department of Psychiatry, Columbus, OH. 

10. 
Lantz, J. (1978). Family and marital therapy. NY: Appleton Century-Crofts. 

11. 
Lantz, J. (1982). Meaning in family therapy. International Forum for Logotherapy, 5, 44-46. 

12. 
Lantz, J. (1986). Family logotherapy. Contemporary Family Therapy, 8, 124135. 

13. 
Lantz, J. (1987). The use of Frankl's concepts in family therapy. Journal of Independent Social Work, 2, 65-80. 

14. 
Lantz, J. (1993). Existential family therapy: Using the concepts of Viktor Frankl. Dunmore, PA: Jason Aronson. 

15. 
Lantz, J., & Harper K. (1989). Network intervention, existential depression and the relocated Appalachian family. Contemporary Family Therapy, 11, 213-223. 

16. 
Lantz, J., & Harper K. (1990). Anomic depression and the migrating family. Contemporary Family Therapy, 12, 153-163. 

17. 
Lifton, R. (1968). Death in life: Survivors of Hiroshima. NY: Random House. 

18. 
Lifton, R. (1973). Home from the war. NY: Simon & Schuster. 

19. 
Lifton, R. (1976). The life of the self. NY: Basic Books. 

20. 
Moon, B. (1990). Existential art therapy. Springfield: Charles Thomas. 

21. 
Shatan, C. (1973). The grief of soldiers: Vietnam combat veterans self-help movement. American Journal of Orthopsychiatry, 43, 640-653. 

22. 
Tick, E. (1989). Sacred mountain: Encounters with the Vietnam beast. Santa Fe: Moon Bear Press. 


The International Forum for Logotherapy, 1994, 17, 20-26. 
FINDING MEANING IN UNAVOIDABLE SUFFERING 
Robert C. Barnes 
In Frankl's concept of unavoidable suffering, he offers us one of the highest forms of bearing witness to the human capacity to turn a personal tragedy into a triumph. We may not be able to change our fate, but, by the defiant power of the human spirit, we can change our attitude. 
The defiant power of the human spirit, more than physical or psychological strength alone, can overcome obstacles and conquer difficulties.1• P-21 We can find a meaning in life even when confronted with a helpless situation. No matter how life calls upon us to suffer, that suffering can have meaning if it changes us for the better. 
Changing ourselves often means rising above ourselves, using self-transcendence, learning to mold even our suffering into human achievement. By self-transcending, we exercise the most creative of all human potentials. 
The logotherapeutic counselor tries to relate the experience of suffering to a meaning the client can accept. When we see meaning in life, we are able to endure suffering. 
An Example From an Unavoidable Divorce 
Douglas, 34, loved his wife and his two children. He worked hard as a petroleum engineer, provided well for his family, was devoted to religious concepts, and reared his children according to the principles of his faith. Unbeknownst to him, Douglas' wife had an affair with a close friend of the family. When she was ready to make the break, she was not interested in counseling to reconcile her marriage. Her mind was made up. There was nothing Douglas could do to dissuade her. 
Frankl defines fate as that which lies beyond our power to control. Douglas' fate was decided by his wife. She said to me, "I do not like thinking of myself as an adulteress. Nevertheless, my lover will also be getting a divorce, and I intend to take my children and establish a new family with the person who will become my second husband." 
Douglas dealt with his grief and was able to cope with his feelings of rejection by considering the greater tragedy that his 6-year-old son and 8-yearold daughter were experiencing. Through a self-transcending change in attitudes, he was able to transmute his unavoidable suffering into a victorious achievement. His faith gave him strength to face his fate instead of being destroyed by it. He reached beyond himself to those he loved and to values in which he believed. He fought for custody of his children. After two weeks of a bitter trial by jury, Douglas won their custody. As a man in his mid-thirties, he was a father with a broken heart but a triumphant spirit. 
Two years later, the children's mother took Douglas back to court for a second emotionally draining custody battle. She had convinced the children they would be coming to live with her and had promised them everything from trips to Disneyland to maid service. After a week in court, when the judge read the jury's verdict that the children would remain in Douglas' custody, he collapsed in exhaustion. He said to me, "I've got to go home and tell the children. Their mother has already instructed them by long-distance telephone to have their bags packed. I don't know how much longer I can handle this." 
I looked at him reassuringly and said, "You have a task that awaits you. You believe in this task with every fiber of your being. You are determined that your children will be brought up in a loving home, where they are taught values that are eternal. Knowing that your children need you, you will never have to wonder if you will have the strength to fulfill your task.· 
Logotherapy Teaches About Meaning in Suffering 
Logotherapy teaches us that in the dimension of the human spirit, we can become the master of our fate, not the victim, even in the face of limitations. Unavoidable suffering gives us the opportunity to bear witness to the human potential at its best, which is to turn tragedy into triumph. 
Frankl wrote, "Whenever one is confronted with an inescapable, unavoidable situation, whenever one has to face a fate that cannot be changed, e.g., an incurable disease, just then is one given a last chance to actualize the highest value, to fulfill the deepest meaning, the true meaning of suffering."1·P·118 "What matters most of all is the attitude we take toward suffering, the attitude in which we take our suffering upon ourselves . . . Suffering ceases to be 
118 119
suffering in some way at the moment it finds meaning."2· P-· Several years ago, my wife Dorothy was diagnosed as having cancer. It broke my heart to realize her pain. Someone said to her, "Why you, Dorothy, 
with all the good you have done and can do with your life?" Her response was, "Why me? Why not me?· She was aware that appropriate handling of suffering is a dimension of serving. Both of us believe that God enables us to use our own pain, not only to enrich ourselves, but also to strengthen others. When cancer appeared again this past October, Dorothy called upon the same faith to help her find purpose and meaning in what she had to endure. Her response reminded me of the words of Nietzsche who said, 'That which does not kill me makes me stronger." 
Elisabeth Lukas gives two eloquent personal examples of such self-transcendence. She tells of her mother's tragic bout with cancer and the triumphant spirit with which she faced it. "She acted with courage, not to overcome her own suffering, but to alleviate ours."3' P-138 
Lukas also tells of her own interaction with Frankl when he suffered a severe heart attack in 1979 during a visit in Munich. She reached him by telephone in the intensive-care unit of the hospital. In her own words, "I wanted to say so much to help, comfort, and thank him, but I couldn't find the words. Here, like Mother at her sick bed, was a person who had more strength than the people around him, and he set an example. He spoke calmly. To die held no terrors for him. He accepted any decision of fate because it was beyond his responsibility ... Thus, he tried to comfort me who myself could not find words. He wanted to tell me, 'Remain calm, too, when you'll face death some day .. .' This was his legacy, a lesson from the hospital bed. He did not think of heart failure--he thought of mel".3• P-139 
No One is Exempt from Suffering 
Paul Tournier wrote, "There is no life exempt from suffering. There is no life which, from birth, does not already have to carry the weight of hereditary weaknesses, no life which does not suffer emotional shocks in childhood, which does not suffer daily injustices, hindrances, 1n1unes, and disappointments. To all this pain must be added sickness, material difficulties, bereavement, old age, worry about loved ones, and accidents. In the lives of even the most privileged there is something that is hard to accept."5' P·143 
Four years ago we lost a good friend, a prominent physician. He had open-heart surgery. This operation has worked for many, but not for him. In the months of his decline, he knew with a physician's insight what was happening. Conscious to the very end, he thought deeply about the preparation for his own death. As a religious person he pondered about how worthy his soul might be for heaven. He recalled the meanings he had actualized during his lifetime--accomplishments death could not void. He had brought 8,000 babies into this world during his career. For years, people drove to him for miles, bypassing other medical centers. He was known for being genuinely interested in the whole person. He listened with an educated ear and a caring heart. He established the mental health center in our city. When patients couldn't pay for their medical care, they received the same high-quality treatments as those who paid. 
A related example of what Frankl calls "tragic optimism" is seen in the courageous attitude of his widow. Someone said to her, 'We had hoped you could have many more beautiful years together. It almost seems you were cheated." She responded, "Cheated? Oh my, no! Many women live a lifetime and never know the love of such a man. What we shared far surpasses what other couples know whose marriage lasted many more years.· "Cheated?" she asked once again. "No, I was significantly blessed." 
The Concept of the Wounded Healer 
I have long believed in the concept of the wounded healer. Those who show an undefeated spirit in desperate circumstances can do something for us that others cannot do. 
Several years ago I heard Rollo May who was 75 at that time. During the question period a woman asked, "Dr. May, you have talked about the wounded healer, but have you known any suffering in your own life? You're an internationally famous psychologist, a widely recognized author. Did you experience any suffering that helped you become the sensitive therapist you are known to be? How might the concept of the wounded healer apply to you?" 
May responded, "I am the second child born to a schizophrenic mother. My older sister is schizophrenic and has been confined for years in a mental hospital. As soon as I could walk, I learned to get out of the house. I became a loner and was very sensitive. My father abandoned us when I was a pre-schooler. I have had heart problems ever since I was four. I fought malaria and was hardly ever without fever from the time I was 20 until I was nearly 30. I also suffered from tuberculosis. From my academic training I gained knowledge to help others, but from my experiences I gained the desire and ability to help them." 4 
Experiences in my Own Life 
In my own life, my mother died when I was three weeks old. Her younger sister came to take care of my 4-year-old brother and me. Later she married my father. When I was five, my new mother gave birth to my brother Richard. 
23 
While she loved all of us, Richard was very special to her. At 18, a drunk driver killed him on his first trip home from college. The week after his funeral, Mother redecorated the nurseries in our church and volunteered as a "nursery home visitor." She gave religious teachings about spiritual aspects of parenthood to expectant mothers in the church. She visited their homes, not to tell about her sorrow. but to help them more meaningfully anticipate their joy. 
I myself live within a body that has major limitations because I had polio when I was 13, two years before the polio vaccine was available. My body is crlppled, but I as a person am not. My soma (my body) became sick. My psyche (my emotions) experienced a healing through the acceptance that my body had limitations, but my life does not need to be shaped by those limitations. Our noetic dimension (our spirit) can never get sick. Somehow in my noetic dimension, even as a teenager, there was an awareness that I am a whole person, that the Creator has purpose for my life, and that no disease took away anything I needed for the tasks that await me. As a spiritual being, I am not even slightly diminished by having a lame leg. In fact, I can truly say that, because of the opportunities I have had to serve and help others, my life is extraordinarily rich in meaning. 
Mary: Meaning In a Victim of Progeria 
A mother made an appointment for me to see her daughter who is a victim of progeria, a disease that causes a child to age 7 to 1O years for every year he or she survives. So rare is the disease that there are only nine progeria patients known to be alive in the world at the present time. A 10-year-old child could easily look like a 100-year-old person, with wrinkled and withered skin, and with eyes bugging out of their bald heads. All body tissues and organs age at the same rate, and they truly become very old while yet very young. 
The mother who called for the appointment told me her daughter was 15 years old. This is older than most progeria patients live to be. Mary's mother said to me, "I understand that you deal with such issues as finding meaning in life. Mary knows she does not have a lot longer to live, and she is struggling with many questions about meaning in her own life." 
Before the hour came for Mary to arrive at my office, I asked God to help me with this challenge. I knew I would need to see beyond Mary's progeria soma, and focus on what could be truly beautiful: her spirit. Mary's mother alerted me that Mary was blind in one eye, and that the other eye was already covered by a cataract. She mentioned too that Mary was the size of a delicate 7-year-old child, and that she would look older than anyone I would ever have seen. She even described that Mary's four front teeth had grown together as one tooth. 
When Mary entered my office, I experienced one of the biggest surprises I have ever had, not because of the grotesque physical appearance, but because Mary walked In with the grace of a ballerina and the charm of a princess. For a moment, I was stunned--and all for the right reasons. Mary was living proof that the spirit within us can never be sick. The instruments of the spirit may become dulled or diminished, but the spirit itself can never be sick! 
Mary's dulled eyes focused on me with a phenomenal intensity. Her smile was so spontaneous that I forgot to look for the unusual teeth. The thoughts of this 15-year-old were so candid that I felt comfortable as her counselor from the moment we were together. I said to her, "Mary, you have much more personal charm and poise than most people of any age. How have you developed that?" She answered, "From the start, my mother prepared me for the world that would have to look at me, but she loved me as if I were the same as everyone else. From as early as I can remember,• Mary said, "I believed something inside me was like something inside everyone else, and so I learned to interact with others on that basis.• 
Mary told the story of when she was a little girl she had a neighborhood playmate whose name was Tommy. They played together and loved each other as dearly as children can. One day Tommy's mother thought it was time to talk to him about Mary's extraordinary physical condition. She said, "Tommy, do you know what the word different means?" "Oh yes, Mama, I know what different means,• Tommy answered. Then his mother asked, "Do you know how Mary is different from other girls and boys?" "Oh," Tommy said, "Mary is different because she has two pairs of roller skates and the rest of us only have one." 
Together Mary and I faced some important questions. We didn't know how much longer she had to live. She no longer had the stamina to stay in school all day every day, and so she had a teacher who came to her home. Yet she had some energy, and she wanted to do something meaningful with her life. She believed me that if she did something solely for herself, she would not find meaning in it. She accepted my suggestion of beginning with a project that would involve helping someone else. I went back to her story about 4year-old Tommy and the roller skates. We agreed that young children have a special gift for accepting others who are different, and for responding to love in a natural way. Mary mentioned her love for children, and that she realized she would more than likely not live to marry and have children of her own. We came up with the idea of her volunteering In a childcare center for little preschool children. 
The last time Mary and I were together, she happily described her schedule of working 2 hours per day, 3 days per week, with 2-and 3-year-old children in a private nursery. She said to me, "I'm happiest on those days. I think of the children as my children. I give them the gift of my love.• 
Concluding Thought 
Let me leave you with this thought: Those who have gone down into the depths of life are most certain of Its heights. Veterans of life with the most scars have found the greatest dimensions of meaning, and believe the struggle most worthwhile! 
ROBERT C. BARNES, PH.D. [Hardin-Simmons University, Box 1211, Abilene, Texas 79698 U.S.A.]. dip/ornate in logotherapy, is chair of the Department of Counseling and Human Development at Hardin-Simmons University and current president of the Viktor Frankl Institute of Logotherapy. 
References 
1. 
Frankl, V. (1973). The doctor and the soul. NY: Vintage Books. 

2. 
Frankl, V. (1965). Man's search for meaning. NY: Washington Square Press. 

3. 
Lukas, E. (1986). Meaning in suffering. Berkeley: Institute of Logotherapy Press. 

4. 
May, R. (1984, March). The wounded healer. Paper presented at the National Convention of the American Counseling Association. Houston, Texas. 

5. 
Tournier, P. (1965). The healing of persons. NY: Harper & Row. 


The International Forum for Logotherapy, 1994, 17, 27-31. 
THE UNIVERSITY DEPARTMENT AS A BASE FOR PROMOTING THE STUDY AND PRACTICE OF LOGOTHERAPY 
Kent Estes and Paul WeHer 
In his letter to President Clinton, Joseph Fabry wrote: "Freedom, used without responsibility, causes families to fall apart, natural resources to be wasted, drugs to be sold, laws to be tested for loopholes, and crimes committed. In education, nothing is more urgent than education for responsibility from kindergarten on." 3·P·25 Sadly, we live in a world where the suffering resulting from these issues is prevalent. 
Education for responsibility is an important focus of logotherapy. Thus the urgent need for promotion of the study and practice of logotherapy was one important theme running throughout World Congress of Logotherapy IX. 
James Crumbaugh, in remarks given at the Congress, suggested that ways must be found to establish the rightful place of logotherapy among the other therapies. 2 A number of other Congress participants expressed the need for promotion and expanded training opportunities in logotherapy and logophilosophy. 
The university is one of several settings where this task may be accomplished. What follows in the present paper are the results of a relevant survey of seven open-ended questions done through the University of Nebraska at Kearney (UNK), where training in logotherapy has been offered by the Department of Counseling and School Psychology starting in 1991. Additional information also is provided that might be helpful to others attempting to make a university department a base for promoting the study and practice of logotherapy. 
The University of Nebraska at Kearney (formerly Kearney State College) is a multipurpose institution of approximately 9000 students, and 26 academic departments. The Department of Counseling and School Psychology awards only graduate degrees and has the largest graduate enrollment on campus, with approximately 200 people working towards masters degrees in either community counseling(100) or school counseling(100). Thirty others are enrolled in the specialist degree in school psychology. Most students work full-time and attend evening classes. There are 11 faculty in the department. 
Fifty people have completed the logotherapy Introductory Training at the University; 10 have completed Intermediate B; 10 have completed Intermediate 
C. Most of these trainees have been graduate students in the Department, or have graduate degrees from the Department. Although most of the trainees live in Nebraska, other participants have been from Kansas, Minnesota, Michigan, Texas, Nigeria, Taiwan, and Nepal. 
The information presented in this paper is from people who completed one or more of the logotherapy training courses at UNK. Twenty-six (20 women; 6 men) participants responded to the questionnaire. Most respondents (17) were in their forties; others ranged from their thirties to sixties. Approximately half of the respondents had degrees in progress in the Department; and approximately half had already completed masters degrees. Occupations included community college instructor (3), mental health therapist (2), teacher (2), social worker (2), school counselor (2), and nurse (2). 
Summary of Responses 
(Note: In some cases, the total numbers in a category exceed 26 because some respondents gave more than one response to a given question. The top four responses are reported for each of the seven items.) 
1. 
How did you first learn about iogotherapy? From a college class with the instructor or coordinator (15) By reading Dr. Frankl's Man's Search for Meaning (4) From a friend (3) From a brochure on the training (2) 

2. 
What concepts in logotherapy motivated you to seek the training? The central orientation and possibility of finding meaning in life (11) The spiritual dimension (7) The idea of choice and responsibleness (6) The healthy core/the dignity of human beings (5) 

3. 
What difference did it make, if any, that the training was associated with the 


University of Nebraska at Kearney? I knew the Instructor and/or coordinator (10) Proximity, therefore convenient, lower cost, a known situation (9) Would not have been aware of the training otherwise (3) Could earn university credit (3) 
4. Tell about a few differences that the logotherapy training has made in your 
life and/or give an example. I have been able to help a family member or strengthen our family life by applying these concepts (7). I have applied these concepts to personal crises and suffering (5) I am now more confident in my ability to help others (5) The training provided me with useful tools for personal growth (dereflection, creativity, viewing my past differently, affirming others' dignity,) (5) 
5. 
Tell how the logotherapy training has Influenced your work and/or give an 

example. Improved ability to use one or more of the following techniques: paradoxical intention, emphasizing the power of the human spirit, self-transcendence, dereflection, stories, attitudinal change, creativity (9) Improved ability to ask effective questions, Initiate Socratic dialogue (6) Established a meaningful small group (3) I am communicating more effectively with family members (2) 

6. 
From your perspective now, what would you like to see kept or changed 


in future training? Keep: The sharing of personal sufferings, triumphs, and experiences of the training participants (5) Keep: The shared learning of the close, bonded class (4) Keep: The use of case studies as one of the training methods (3) Keep: The Instructor and coordinator (3) Change: Form smaller groups (2) Change: Provide more material in printed form (1) Change: Provide more practice of techniques (1) Change: Provide less practice of techniques (1) 
7. What else would you like to say about logotherapy, or the training at UNK? Keep the instructor and coordinator(9) Continue to offer these opportunities (5) The UNK learning environment was a good one (4) Logotherapy is valuable both with self and clients (3) 
Conclusions 
Participants were attracted to logotherapy training by several factors: a) both the trainer and coordinator introduced logotherapy concepts in other graduate classes; b) these two departmental faculty members offered a "known quantity" to participants; c) the trainer was described as a genuine and effective representative of logotherapy, and d) the university was a close, convenient location, thus eliminating many of the travel costs and other expenses often associated with such training. 
The concepts of logotherapy Itself attracted trainees. Respondents named many of Frankl's teachings that invited them to learn more, including the spiritual dimension/human dignity /healthy core and the central concept of meaning in life. Students Indicated that these life-affirming ideas were an oasis in a sometimes arid psychological landscape. 
Respondents had applied the tenets and practices of logotherapy to their own lives, to help others, and in their workplace. Parts of the training required the participants to apply logotherapy concepts and methods to case studies In books by Frankl and Lukas, and also to bring two case studies from their own experience. In terms of Bloom's Cognitive Taxonomy, the training was kept above the levels of memory and simple understanding. 1 The application, analysis, synthesis, and evaluation of logotherapeutic concepts and methods probably provided the basis for this carryover from training to life and work. 
The Dean of the College of Education and the Chair of the Department of Counseling and School Psychology are fully supportive of the training at UNK. The Department Chair served as the coordinator of each training event, and he made the training known to graduate students in the Department, thus eliminating most advertising costs. He secured the best seminar rooms, arranged for college credit for those students desiring It, planned for meals and breaks, and took care of many "comfort and caring" details. Because the coordinator had effective group counseling skills, he was able to help the trainer with small-group work. The trainer and coordinator are not only colleagues but also good friends--trainees mentioned that this relationship served as a model for participants. 
Every effort was made to connect the training participants with the larger logotherapy network. For example, six of the trainees attended the World Congress IX at Toronto. Also, during the training, frequent references to articles in the International Forum for Logotherapy helped the trainees to widen their logotherapy horizon. 
Frankl has observed: "It has frequently been asked to what extent psychotherapy can be taught and learned.• 4•P-266 Part of his answer to this question follows: 
... if logotherapy had nothing more to offer than making 
conscious, explicit, and methodological what had formerly 
been achieved by intuition and improvisation, that in itself 
would be a worthwhile achievement, for by that very fact it 
would have become teachable and learnable.4·P-266 
The University department has a certain "face validity" as a location for making logotherapy "conscious, explicit, and methodological," inasmuch as the university seeks to accomplish these three goals with all its curricular offerings. Our survey responses support Frankl's belief that logotherapy is "teachable and learnable"' and also support the university department as a workable setting for the teaching and learning venture. 
KENT ESTES, ED.D. [Department of Counseling & School Psychology, University of Nebraska at Kearney, Kearney, Nebraska, 68849, U.S.A.] is department chair and associate professor, a nationally certified counselor, and a state certified professional counselor. He is primarily engaged in counselor training. 
PAUL WELTER, ED.D. [P.O. Box 235, Kearney, Nebraska, 68848, U.S.A.] has recareered into writing, leading seminars, and telling stories after leaving the University of Nebraska at Kearney in 1992. He is a counseling psychologist and diplomate in logotherapy. He teaches short courses at the University, including Logotherapy Training and Learning from Children. 
References 
1. Bloom, 8., et al. {1956). Taxonomy of educational objectives: Handbook 
I. Cognitive domain. NY: David McKay. 
2. 
Crumbaugh, J. {1993, July). The ecce homo technique. Paper presented at World Congress of Logotherapy IX, Toronto, Canada. 

3. 
Fabry, J. (1993). Joe Fabry letter to president Clinton. The International Forum for Logotherapy, 16, 25 & 42. 

4. 
Frankl, V. {1955). The doctor and the soul. NY: Vintage Books. 


The International Forum for Logotherapy, 1994, 17, 32-41. 
LOGOTHERAPY IN THE CLASSROOM 
Robert A. Wilson 
The need for an educational model built on the concepts of logotherapy is crucial. Never before have we experienced the utter fear and anxiety of children in our school system. 
Children in today's schools are exposed to social and emotional stressors that are influencing their ability to learn. Each day In the U.S.A. 2,795 teenagers become pregnant; 1,106 of them later have abortions; 211 teens are arrested for drug abuse; 437 teens are arrested for drinking and drunken driving; 10 children die from gunshot wounds; 1,512 drop out of school; and 6 young people commit suicide. In California, every day 298 children see their parents lose their jobs, 151 teens drop out of school, and the numbers are escalating. Learning becomes more difficult as the turmoil increases. 1 
Educators are seeking help and guidance In dealing with these monumental problems of youth. These problems permeate the classrooms and most teachers are not prepared to meet this dilemma. School counselors and school psychologists must have the necessary skills and training to assist the educational staff since they are on the ''front-line" in educational guidance. An organized, structured, systematic tool is necessary for use in the curriculum. 
Frankl's meaning-centered principles and optimistic theories provide such a tool. Logotherapy's three assumptions--Freedom of Will, Will to Meaning, and Meaning of Life--are compatible with the curriculum and can become the foundation for classroom techniques and a counseling strategy. 
The most useful technique of logotherapy within the school setting is the Socratic dialogue. It is a problem-solving, questioning strategy. Its objective for educators is to bring out the ability of the students to make authentic and independent decisions on what is essential and meaningful. Frankl states that the human being is "by no means a product of heredity and environment. 
There is a third element: decision. Man decides for himself! And, in the end, education must be education toward the ability to declde."4' p.xix 
The Socratic Dialogue Process 
Decisions are made in the individual's spiritual, uniquely human, dimension. This is also the dimension that tells you what kind of person you are, what your potentials are, and what is important and meaningful to you. Socrates believed it was the task of the teacher, not to pour information into the students, but rather to elicit from them what they know intuitively. Therefore, It is the task of the teacher /counselor not to tell students what the meanings in their lives are, but rather to elicit the wisdom that is hidden within their spirit.2' P-9 
The Socratic dialogue probes five areas in which meaning is likely to be found: 2• P-10 
1. 
Self discovery: The more you find out about your authentic self behind all the masks for self-protection, the more meaning you discover. 

2. 
Choice: The more choices you see in a situation, the more meaning becomes available. 

3. 
Uniqueness: Every person is unique in a string of unrepeatable situations. We are distinctly creative. We all are specialists (in a special world). 

4. 
Responsibility: Life is meaningful if you learn to take responsibility in areas where you have choices, and not to feel responsible when you face an unalterable fate. 

5. 
Self-transcendence: Meaning comes to you when you reach beyond your egocentricity toward others. In the Socratic dialogue process the teacher plays the role model. Frankl 


stresses that values must be lived rather than taught. "What a teacher can give to students is not meaning but example.''3' p.a 7 The living of values and meanings are an integral foundation of education, paying attention to the human dimension. Value exploration and awareness of one's conscience are also aspects of the Socratic dialogue. "Conscience is seen as the intuitive capacity of human beings to find out the meaning of a situation."3' p.ea Therefore, "through value exploration and conscience, meaning becomes the primary goal, and the will to meaning the basic motivation."5' P-94 
33 
Socratic Dialogue in the Classroom: A Strategy 
A plan for Socratic dialogue in the classroom can consist of three phases: 
1. 
The Dialogue Phase: During this phase, questioning, probing, responding, and Improvisations are directed toward the five areas of meaning potentials: self-discovery, choice, uniqueness, responsibility, and selftranscendence. This can be done spontaneously or by using a series of structured questions. I have worked out such questions leading to each of the five areas (Questions that Enhance Meaning, available from the author). 

2. 
The Meaning Triangle (see figure below): Students are asked to identify the area of the triangle which they have found most meaningful. Questions are asked of what, how, where, and when. Students are divided into small groups for problem-solving, or they stay in large groups for discussions. 

3. 
Assignments: Assignments for the next session are given either for groups or for Individuals. This procedure blends in well with various curriculum assignments. These assignments (mini-responsibilities) can be accomplished by "homework" and by "sharing-time" with parents in a problem-solving mode. 


A1'lTll'UDl!NAJL 
(Spiritual) "acceptance for an unchangeable fate" "not to do what you want--but what is called for" 
The stand we tuke toward aJi.Ile we can no longer change 

MEANING TRI.ANGLE 
CREATIVE---------------""'-XPER ENTAL 
CruBATIVlB JBXJP]BllUlBNTl[AJL (What we give) "Experiencing mhers" "Doing a Deed" "Encounters" "Achieving in work" "Love" "Accomplishmem" "Anuming responsibility to Jeff ·'What we give ro liji! and others" "What we tuke from the world" 
Socratic Dialogue in the Classroom: Group Processes 
Socratic dialogue gives the group a foundation and acts as a catalyst for interaction, exploration, and problem solving. Participants are not to try to solve problems for each other, rather the discovery of meaning remains the responsibility of the individual.2' P-113 This allows participants to identify and choose the meaning in each example--a crucial element. 
The purpose of the group process is for the group members to gain insights from each other through acceptance and approval. The insights are not initiated by the group leader, but from the group members, as they have taken an equal risk of sharing and of being understood. Three things are learned from this: 8' P-255 
1. 
Others feel, behave, and think, too. 

2. 
Everyone's specific feelings, behaviors, and thoughts are uniquely his/her own. 

3. 
If each person is thus unique, then I must be unique. 


2 114
General guidelines for the group process are: • P
1. 
Create a supportive atmosphere in which communication in its freest, most uninhibited, most personal sense can take place. The goal of this guideline is trust. 

2. 
Make participants aware of the resources of the human spirit: selfdiscovery, choice, uniqueness, responsibility, and self-transcendence. This guideline is operable and realistic. Students respond most enthusiastically. 

3. 
Help participants become aware that it is in their power to use these resources to find meaning directions. This is a fundamental guideline, compatible within the group process. 

4. 
Assist participants to discover where they are, where they want to go, and how they plan to get there--step by step. This guideline is cognitive-oriented and desirable for the learning process. 

5. 
Focus attention on what's right with each participant, and focus on how group members can learn from what they think is wrong with them. This guideline offers the opportunity to each participant to review the Socratic dialogue process, and it reinforces the thinking aspects of finding solutions within the logotherapeutic design. A key factor in the group process is responsibility. Two aspects are 


relevant in the school setting. "Each member accepts responsibility for the life of the group ...and makes the present situation the focus of [the participants') attention, but without ignoring the past."2• P· 114 Concentrating on the what rather than on the why is a cognitive function and blends into the academic mode. Although the why is important, it is secondary to the what--particular1y in the Socratic dialogue process. 
The Five-Step Approach, developed by Elizabeth Lukas, with regards to responsibility, has been most effective in the school setting. It has been used in both group and individual counseling and has been most successful for classroom teachers applying Socratic dialogue. 
In the Five-Step Approach the following questions are discussed: 
1. 
What is your problem? 

2. 
Where is your area of freedom? 

3. 
List your choices within your area of freedom. 

4. 
Which of the choices is the most meaningful to you? 

5. 
What is your first step in the direction you have chosen? 2• P-34 


Feedback from Practical Applications 
Teacher Reports-Strategy: Socratic Dialogue in the Classroom 
Marie Tocchio (Special Day Class Teacher, Kings Canyon Middle School, Fresno Unified School District). Results of using the Socratic dialogue process: 
1. 
Students with poor thinking and reasoning skills are now able to associate Socratic dialogue usage to the problems (topics) and work out solutions. 

2. 
Students with attending problems who do not usually pay attention, will now pay attention and sometimes dominate the discussion. They respond to the "checks" after their names when they respond. 

3. 
Although it has taken considerable time for students whose second language is English (ESL) to respond to the process and find a pattern, by giving cues and taking time Socratic dialogue has been very effective. 

4. 
Students with auditory memory processing difficulties are able to conceptualize and respond to the Socratic process if visual aids (cards) are used so they can follow along. 

5. 
Students who were shy now respond more freely. The atmosphere is more positive. Students are now more focused since the Socratic process has been in effect. 

6. 
Socratic Dialogue Ideas: 


(a) 
Use of newspaper and magazine articles to relate to the Meaning Triangle. 

(b) 
Life experiences offered on field trips and through speakers are appropriate in relating back to the Meaning Triangle and the Socratic format. 

(c) 
Use of fables and stories in problem-solving and relating to the Triangle and the Socratic process. 

(d) 
Be spontaneous. Take-off on words and phrases and have students expand on each word or phrase. Relate to the Triangle or Socratic format. 

(e) 
Refer to the packet, Questions that Enhance Meaning (available from the author). 

(f) 
Utilize the Five-Step Approach by Lukas which illustrates a responsibility format. Students respond to this process by demonstrating on the chalk board, and dividing into teams for group dialogue. 

(g) 
Homework: Assign topics or have students go home and think of a problem. Have them go through the process on their own. Get parents involved. Have students solve the problem by themselves or with their parents, and share with the class the next day. (Extra credit is given for this assignment.) 


Julie Serjak (3rd Grade Teacher, Palo Verde Elementary, Tulare School District). I have used Socratic dialogue continually in my classroom for the past two years. It has had a positive effect on my overall teaching style. Socratic dialogue allows me to present the curriculum in a manner which presents new ideas and Information to my students, and elicits from them knowledge and wisdom that is innate within them. 
At the beginning of each school year, I have my Meaning Triangle posted in the classroom. We then spend several days discussing each point on the Triangle--attitudinal, creative, and experiential--and how they are all inter-dependent. As we begin to focus on the five guideposts of Socratic dialogue we connect each of these areas to a point on our Triangle and discuss how they interface with each other. 
After the class has become familiar with the basic framework of Socratic dialogue, we focus on a particular area and present a topic for discussion. During this discussion, I guide the children toward self-discovery. They learn to look at their choices, see themselves as unique individuals, and take responsibility for themselves and their decisions. At the beginning of the year, we set aside a specific time each day to use the Socratic process. After we do this for a month or two, I find that we are approaching a great deal of our curriculum in this manner. 
The Socratic dialogue process helps students gain confidence to know they are unique individuals with much to offer one another. This method allows the teacher and student to develop strong and positive communication with each other. Example: A little girl had just experienced the death of her grandfather. She had to make a decision whether or not to attend his funeral. She was having difficulty working through her feelings, and with the help of Socratic dialogue was able to reach a decision that she felt good about. 
Gloria Gonzalez (Counselor jTeacher, Golden West High School, Visalia Unified). I am presently developing a logotherapeutic model for the classroom, applying the logotherapy process with students whose second language is English (ESL). We begin the logotherapy process by introducing the logotherapy approach through the use of visual aids and specific examples to clarify vocabulary. Information is given regarding the Socratic format using the five guideposts to search the areas where meaning is most likely to be found. The Meaning Triangle is presented, and the three fundamental assumptions are discussed and explained: Freedom of Will, the Will to Meaning, and the Meaning of Life. 
The Five Step Approach by Lukas, regarding problem solving, is used to assist students toward the will to meaning through self-discovery and responsibility. 
Every school year, I try to reaffirm my belief in the value of the individual and consider that each of us (teacher /counselor) is needed to accomplish the learning goals we set together. It is essential to believe in our hearts that the goals we want to reach are achievable and that our students can achieve them. We teach and counsel who we are. Therefore, we must serve our children as role models worthy of belief. Being a role model is not a simple task--but students need and are nurtured in an environment where a teacher /counselor lives his/her values. These values are learned through experience and Imitation, and children can pick them up by discovering what is important, valuable, and meaningful. I believe in character-building education with cognitive learning. This gives us our humanity. 
A diversity of ways can be applied in a classroom setting and/or counseling environment to enhance the search for meaning: 
Listen to students. Understand how children learn and be able to apply appropriate strategies. Engage in open-minded, non-judgmental discussion of problems (personal, behavioral, academic) of concern to student(s) in an effort to find collective solutions. Foster a warm, supportive, and constructive relationship with students. Focus on the positive. Laugh easily. Encourage creativity. Praise positive behavior and sustain effort as much as high marks. Be sensitive to the feeling of self-worth. Enhance self-perceptions. Model behavioral, cognitive, and affective expectations. Love your work. Be idealistic. Let students know you care and believe in them. Know thyself. 
Student Papers-Strategy: Using Socratic Dialogue in Accepting One's Fate 
Zeljka Buljan (Senior, Mrs Gonzalez's class). LIFE BRINGS CHANGES 
Two years ago, I had a normal life, went to school, had lots of friends, was involved in sports, and enjoyed life with my family. My life was a nice story. 
But then something happened. My country, Croatia, became independent and the Serbians started a war against us. My town, on the Serbian border, was attacked first. My parents decided to take my sister and me to my grandparents who lived far from Serbia. 
The trip was long and terrible. The Croatian army stopped us almost every mile. When we arrived at my grandparents, my parents had to go back. They left us without knowing what the future would hold. 
Then the nightmare started. The Serbians bombarded my hometown, and my parents were in the middle of hell! My father had to go to the army, and my mother lived in the basement, the safest place. 
I could not call home, all I heard were rumors. I heard that my father was wounded two times, then I heard he was dead. I did not believe it--1 just couldn't! I watched the news every half hour. It usually said that many people were killed. 
After four months of uncertainty, the Serbians occupied my hometown. I'm never to forget that day. My sister and I watched the news as they explained what was going on. Then the telephone rang, it was mother. I recognized her voice and started to cry! I couldn't speak. She brought terrible news. My father was arrested, and nobody knew where he was. Finally, we found him in a Serbian jail. We couldn't help him. I felt bad because my mother was worried about my father. I thought I'd never see the smile on her face again. After several months of waiting, my father was exchanged. I didn't recognize him. He was very weak and had lost half of his weight. But the most important thing was that we got together as a family. Eventually we were able to emigrate to America. 
Life brought changes in my life too ear1y. But the suffering had a valuable lesson for me which I realized through my teacher in my new school. I learned to appreciate what really mattered in life--my family, friends, and loved ones! I lost material possessions, but not what is truly meaningful in life. Life is not perfect. In spite of the suffering I have gone through, I chose not to lose my faith, but to look to the future with a meaningful purpose--to grow toward a vision that also embraces joy; for life is made to include both joy and suffering. It is not good to hate--forgiveness is better. I must put these things behind me and look for a new and deeper meaning. 
Joua Lee {Senior, Mrs. Gonzalez's class). ESCAPE 
In 1986, when the Communists entered our city in Laos, everything changed in a bad way. The soldiers were brutal. The Vietnamese tortured Hmong people. They tied the person's wrist and pulled together the rope over a tree branch, so the person was hanging, cutting him with knives. The Vietnamese killed my uncle like that, too. 
They came into our house and looked for my dad. They wanted to kill him because he was a leader in our village. But he had hidden in the mountains. After one week, he came back looking for food but the Vietnamese had taken all our rice and killed our chickens and pigs. My father told us to escape from Laos immediately. We were seven children. Many villagers people left with us also. 
It took ten days to walk over the mountain to the Mekong River which separates Laos from Thailand. Some people died of hunger or disease or were killed by the Vietnamese. We fished in a little river. If the small children cried, the parents covered their mouths with their hands. When we got to the Mekong River, we saw many wounded people. Some were staggering around. 
One woman was dead, but her children held her embraced as if she was sleeping. 
The Vietnamese soldiers killed people who were trying to escape. We stayed in the mountains for two days and tried several times to escape at night, but we couldn't. Some people from Laos had bamboo rafts and took us across the river to Thailand for much money. 
The children were all sick. I worried that I might die of sickness. I told myself to try my best to stay healthy. It took us ten more days to walk to Ui-nai. I am thankful that now my family and I are safe in our new country, America. 
Even though I have experienced much sadness, I try not to live sadly. We live in this world and need to go the next step and not get lost in the past and its sadness. We must move ahead in our lives and live our lives better and better, and no one can make that choice for me but I! I must be responsible for myself. So, I choose to find meaning in becoming a teacher some day, to help people who also have had sadness in their lives. 
ROBERT A. WILSON, PH.D. [Fresno Pacific College, 1717 S. Chestnut Ave., Fresno, California 93702 U.S.A.] diplomate in logotherapy is director of school counseling and pupil personnel services, Fresno Pacific College, Fresno, California. He is former director of psychological services, Fresno Unified School District. 
References 
1. California School Counselors Association 'Info'. (1993, Fall). Fullerton, California, p. 1. 
2. 
Fabry, J. (1988). Guideposts to meaning. Oakland: New Harbinger. 

3. 
Frankl, V. (1967). The will to meaning. NY: The American Library. 

4. 
Frankl, V. (1973). The doctor and the soul. NY: Simon & Schuster. 

5. 
Frankl, V. (1978). The unheard cry for meaning. NY: Simon & Schuster. 

6. 
Lieban-Kalmar, V. (1984). Logotherapy: A way to help the learning disabled help themselves. Academic Therapy, 19, 265. 


The International Forum For Logotherapy, 17, 42-46. 
ADAPTING THE LIFE PURPOSE QUESTIONNAIRE FOR USE WITH ADOLESCENT POPULATIONS 
Robert R. Hutzell and Willis C. Finck 
(ABSTRACT) This study used two groups of high school students (N= 100 subjects per group) and showed that a shortened version (18 items) of the Life Purpose Questionnaire (LPQ) may be useful for measuring the degree of life-meaning in adolescents. 
The Life Purpose Questionnaire (LPQ) originally was developed as an uncomplicated, easily administered, paper-and-pencil measure of life-meaning and purpose for institutionalized, geriatric individuals.2 It was designed to measure the same concept as Crumbaugh's Purpose-in-Life (PIL) test. 1 The LPQ Overview Sheet suggests adequate reliability and validity with geriatrics and also reports on the use of the LPQ with other adult populations.3 
Because the LPQ items were designed to be easily understood and to require minimal administration time, the LPQ might be a useful measure of the degree of life-meaning experienced by children and adolescents. The present paper reviews an investigation designed to adapt the LPQ to adolescent populations. 
Two groups of subjects were recruited from four high schools in the San Jose area of California. One group (Volunteer) agreed to take the LPQ for research purposes. The other group (Support) participated in student support groups and agreed to complete the LPQ as part of their support group work. The support groups were designed for: persons who were then using drugs/alcohol; persons who wanted support while recovering from drug/alcohol abuse; persons whose lives were disrupted by drug/alcohol abuse by family or friends; and persons who had family issues other than drug/alcohol abuse. The students completed the LPQ in small numbers led by the classroom teacher or their group leader. Students were freshmen through seniors and ranged in age from 14 through 18. Three-fourths of the subjects were female. Data were analyzed for 100 subjects from each group who had completed the LPQ. 
Each of the 20 LPQ items was correlated with the total score of the remaining items. This was done for both groups. These remainder, pointbiserial correlations ranged from .09 (item 7, Support group, the only correlation that was not statistically significant at p<.05) to .62 (items 9 and 19, Volunteer group). 
Upon reviewing the items, 7 and 15 appeared to have questionable face validity for younger persons. Item 7 was about retirement; item 15 about preparation for death. Indeed, item 7 produced the only non-significant correlation. The correlations for item 15 were in fact in the opposite direction from the adult populations' scoring. Thus, items 7 and 15 were eliminated and should not be scored when the LPQ is used with young persons. 
The correlations for the remaining 18 LPQ items ranged from .21 to .55 for the Support group, averaging .37. The correlations ranged from .23 to .62 for the Volunteer group, averaging .48. 
Using logotheory, one would hypothesize that the Support group would have less meaning in life than the Volunteer group. Using the 18-item LPQ, the Support group mean score was 10.6 (SO=4.1), while the Volunteer group mean score was 12.5 (SO=4.5). This difference was statistically significant (tdf•198=3.13; P2-tal1ed<.01). 
Using the axiom that the middle 50 percent (M ± 2/3 SD) of the population is labeled normal or average, LPQ18 scores of 0-9 would be considered below average for adolescents; 10-15 would be considered average; and 16-18 would be considered Above Average. Using these cut-off scores, 42 percent of the Support group scored below average, only 23 percent of the Volunteer group scored below average. 
For the Volunteer group, scores were not significantly correlated with: a) sex (r= .05), b) whether or not the subject was living with both parents (r= .17), 
c) age (r=.01), or d) year of high school (r=.04). 
Twenty-four subjects in the Support group completed their support sessions and were re-administered the LPQ. The Initial LPQ18 score for this subset was 9.2 (SO=4.2). The final LPQ18 score went up to 10.3 (SO=3.5). However, this increase was not statistically significant (tdf=2a = 1.13). 
The results of this investigation suggest that the LPQ can be a useful measure of the degree of life-meaning in adolescents. Further study is needed comparing the LPQ18 with the PIL, as well as with non-test data, from adolescents. 
ROBERT R. HUTZELL, Ph.D. [P. 0. Drawer 112, Knoxville, Iowa 50138, U.S.A.] dip/ornate in logotherapy, is a clinical psychologist at the VA Medical Center in Knoxville, Iowa and director of psychology at a multi-specialty medical clinic in Knoxville. 
WILLIS C. FINCK [P. 0. B. 2852, Saratoga, California 95070, U.S.A.] is executive director of the Viktor Frankl Institute of Logotherapy in California. After 32 years of public high school teaching and counseling, he currently works as a consultant and group facilitator in several high schools. 
References 
1. 
Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl's concept of noogenic neurosis. Journal of Clinical Psychology, 20, 200-207. 

2. 
Hablas, R., & Hutzell, R. R. (1982). The Life Purpose Questionnaire: An alternative to the Purpose-in-Life test for geriatric, neuropsychiatric patients. In S. A. Wawrytko (Ed.), Analecta Frankliana (pp. 211-215). Berkeley: Strawberry Hill. 


3. Hutzell, R. R. (1989). Life Purpose Questionnaire overview sheet. Berkeley: Logotherapy Press. 
LPQ Adolescent Data 
LP0 item (and scoring) Support Group Volunteers 
% marking  r.  with Remainder  % marking  [. with Remainder  
Disagree  Total Score  Disagree  Total Score  
1.  I am often bored.  (D)  53  .35  70  .45  
2.  In general, my life seems dull.  (0)  77  .32  85  .47  
3.  I have definite ideas of  
things I want to do.  (A)  25  -.25  18  -.38  
4.  My life is meaningful.  (A)  23  -.44  20  -.61  
5.  Most days seem to be the  
same old thing.  (0)  43  .35  47  .43  
6.  If I could live my life again,  
I would live It pretty much  
the same way I have.  (A)  69  -.24  50  -.56  
7.  Retirement means a time for  
me to do some of the exciting  
things I have always wanted  
to do.  (A)  35  .09  42  -.42  
8.  I have made only a little  
progress toward reaching my life  
goals.  (0)  45  .33  53  .34  
9.  My life is kind of empty.  (0)  63  .50  80  .62  
10.  If I should die today, I would  
feel that my life has been  
worthwhile.  (A)  49  -.40  39  -.60  

11. 
In thinking of my life, I often wonder why I am alive. (0) 

12. 
My life does not seem to fit well into the rest of the world. 

13. 
I am usually a reliable, responsible person. (A) 

14. 
People usually don't have much freedom to make their own choices. (0) 

15. 
I am not prepared for death. (0) 

16. 
Sometimes I think that suicide may be a good way out for me. (0) 

17. 
I am usually able to think of a usefulness to my life. (A) 

18. 
I have much control over my life. 

19. 
My daily tasks are kind of boring. (0) 

20. 
I have discovered many reasons why I was born. (A) 


66 
(0) 71 15 
51 35 
71 22 
(A) 42 31 47 
.21 .49 -.21 
.34 -.21 
.45 
-.36 -.55 
.41 -.39 
61  .37  
78  .53  
13  -.23  
60  .33  
42  -.23  
83  .50  
16  -.59  
25  -.61  
53  .62  
38  -.48  

The International Forum for Logotherapy, 1994, 17, 47-55. 
Logotheory and logotherapy: Challenges, opportunities, and some empirical findings 
Gary T. Reker 
(ABSTRACT) This paper points to empirical ways through which some of the challenges and opportunities facing logotherapy and /ogotherapists can be met. A number of studies are reviewed which demonstrate that meaning contributes to the physical, mental, and psychological well-being of the individual. Other studies are reviewed which show that meaning buffers the impact of stress on physical health and enhances levels of psychological well-being and self-esteem. Implications of the findings for theory, research, and practice by logotherapists are discussed. 
In 1977 I was told by my empirically oriented colleagues that the topic of meaning was a concern for philosophers, historians, and humanists, but not psychologists. I was told that meaning was something that was not amenable to measurement. I challenged that position. For the next decade, inspired by the writings of Viktor Frankl, I set out to operationalize the construct of personal meaning. 
I developed the Life Attitude Profile-Revised (LAP-R), a 48-item, 7-point measure of meaning and purpose in life and the search for meaning.2'7'8 The LAP-R consists of six factorially derived dimensions: purpose, coherence, life control, death acceptance, existential vacuum, and goal seeking. The combined subscales of purpose and coherence operationalize personal meaning. Purpose refers to having life goals and having a mission in life and having a sense of direction from the past, in the present, and toward the future. Implicit in purpose is the notion of worthwhileness and what is of central importance in a person's life. Coherence refers to having a logically integrated and consistent analytical and intuitive understanding of self, others, and life in general. Implicit in coherence is a sense of order and reason for existence, a clear sense of personal identity, and greater social consciousness. Thus, personal meaning is a dual-component construct. 
I developed a companion scale of sources of meaning called the Sources of Meaning Profile (SOMP). The SOMP is a 16 item, 7-point scale of how meaningful respondents find a number of sources of meaning to be in their life (e.g., personal relationships, traditions and culture, personal achievement, financial security, etc.). Through factor analysis, the 16 sources were further grouped into four categories: self-transcendence (sources that transcend the self--e.g., altruism), collectivism (sources that focus on the societal good--e.g., cultural ties), individualism (sources that focus on enhancement of the individual--e.g., personal growth), and self-preoccupation (sources that focus on self-interests or that are self-serving--e.g., material possessions). 
Both scales, available on request from the author, have been used in a number of studies to test hypotheses derived from Frankl's logotheory;3'5 to 
9 10 12
examine the link between meaning and health outcomes; '• and to identify the mechanism by which meaning promotes health.6' 11 What follows are summary descriptions of the findings of these studies. 
Review of Some Empirical Findings Evaluation of Basic Hypotheses 
Frankl's principal proposition and the associated corollaries lead to a number of testable hypotheses: a) given that the will to meaning is a primary and universal human motive, it should remain relatively high for individuals at all age levels; b) given that the discovery of meaning and purpose requires time and maturity, they should increase with advancing age; c) given that a deeper sense of meaning can only be discovered when an individual moves toward a self-transcendent state, those individuals who derive meaning from several self-transcendent sources should experience a greater degree of ultimate meaning. 
In a test of the first two hypotheses, we assessed the life attitudes of 300 men and women at five developmental stages from young adulthood to old age (16 to 93 years).8 As predicted, no significant age differences were found for the Will to Meaning subscale of the original Life Attitude Profile (LAP); the scores remained uniformly high at every developmental stage. Life purpose showed the predicted linear increase with advancing age. The elderly reported higher levels of life purpose compared to middle-aged and younger respondents. 
The third hypothesis was tested In a study exploring the depth, breadth, and thematic content of sources of meaning (Purpose + Coherence = Personal Meaning) across the life span.!! A total of 360 young, middle-aged, and older adults completed both the LAP-R and the SOMP. The SOMP sources of meaning were categorized into four "depth" levels of Increasing comprehensiveness. While all four SOMP levels were significantly correlated with purpose, coherence, and personal meaning, self-transcendence was the strongest predictor (see Table 1). Comparisons of SOMP levels with each other showed that the correlations of SOMP levels with the components of meaning increased significantly and in direct proportion to commitment to more comprehensive levels of sources of meaning. In other words, individuals who find meaning from sources transcending self-interests experience a greater degree of purpose, coherence, and ultimate meaning in life, supporting Frankl's theoretical view. 
Table 1 
Correlation of SOMP levels with measures of purpose, coherence, and personal meaning 
Personal SOMP Levels Purpose Coherence Meaning 
Self-transcendence (ST)  .31***  .53***  .49***  
Collectivism (C)  .23***  .38***  .35***  
Individualism (I)  .12*  .15**  .16**  
Self-preoccupation (SP)  .11 *  .11 *  .12*  

*** Q < .001 ** Q < .01 *Q <.05 (two-tailed) 
Meaning and Health 
According to Frankl, positive affective states such as happiness are by-products of having fulfilled one's meaning. Happiness cannot be pursued for its own sake; it must ensue. It follows that individuals who experience a deeper and broader sense of meaning and purpose enjoy better health as expressed through greater life satisfaction, higher levels of psychological and physical well-being, and positive mental health. 
In the life-span study of 300 men and women cited above, life-purpose was significantly correlated with psychological and physical well-being for young (16-29 years), early middle-age (30-49 years), late middle-age (50-64 years), young-old (65-74 years), and old-old (75-93 years). Psychological well-being is a measure of the presence of positive emotions (e.g., happiness, joy, peace of mind) and the absence of negative emotions (e.g., fear, anxiety, and depression). Physical well-being is a measure of self-rated physical health and vitality coupled with perceived absence of physical discomfort.8 
In a second life-span study of young (N =120), middle-aged (N =120), and older (N =120) males and females, the impact of breadth of meaning on personal meaning, psychological well-being, and physical well-being was examined.5 Breadth of meaning was operationally defined as the number of sources on the SOMP measure rated as either "very" or "extremely" meaningful. Scores on the breadth distribution were split at the median to form two groups: low breadth and high breadth. Figure 1 shows the results for personal meaning as a function of breadth of meaning and age group. Results for psychological and physical well-being are presented in Figure 2. The findings show that breadth of meaning culminates in heightened feelings of ultimate meaning and psychological well-being for all age groups. Breadth of meaning had no impact on the physical well-being of young and middle-aged adults, but older adults high on breadth enjoyed greater perceived physical health compared to those low on breadth of meaning. 
70 
HIGH BREADTH 
65  
PERSONAL MEANING  60  
55  


YOUNG MIDDLE OLDER AGE GROUP 
Figure 1. Personal meaning as a function of breadth and age. 
PSYCHOLOGICAL PHYSICAL WELL-BEING WELL-BEING 
55
55 
HIGH BREADTH 

50
50 
HIGH BREADTH 
45
45 
40
40 
35
35 

LOW BREADTH
,-T I I 
YOUNG MIDDLE OLDER YOUNG MIDDLE OLDER AGE GROUP AGE GROUP 
Figure 2. Perceived well-being as a function of breadth and age. 
In a another study of the profile and processes of successful aging, 186 community residing and institutionalized elderly completed a battery of measures, including the LAP. 12 The successful agers were defined as those who enjoyed a relatively high level of physical health, psychological well-being, and competence in adapting to the changes that generally accompany growing old. Personal meaning was found to be significantly higher in the successful elderly compared to their unsuccessful counterparts. Furthermore, personal meaning was found to be a potent predictor of positive health indicators such as happiness (Beta = .36, p < .001) and perceived well-being (Beta = .27, p < .001), and the absence of negative indicators such as depression (Beta = -.47, p < .001) and psychopathology (Beta = -.34, p <.001). 
Meaning in Health Promotion 
In the previous studies, meaning was identified as a powerful personal resource that is importantly linked to a variety of health indicators. A related question is the nature of the mechanism through which meaning promotes health. Meaning may operate to reduce the impact of stress on an individual, leading to better health. Meaning may function as a stress moderator (buffer), a stress mediator (damper), a generalized health-enhancer, or some combination of these. 
In a study addressing these issues, 103 community adults, ranging from 60 to 90 years, completed measures of everyday stress, personal meaning index (PMI), perceived well-being, self-esteem, and physical health.6 It was found that meaning functioned as a stress buffer for physical health. Figure 3 shows that elder1y adults low In personal meaning had increasing physical symptoms under high levels of everyday stress; whereas elder1y adults high in personal meaning were virtually unaffected by stress. In addition, as shown in Figure 4, personal meaning enhanced levels of perceived psychological well-being, perceived physical well-being, and self-esteem (a high score means lower self-esteem). 
54 
LOW PMI (-1 SD) 
52 
TOTAL 
50 
PHYSICAL SYMPTOMS 48 
HIGH PMI (• 1 SD) 
46 
T  
0  10  20 30  
EVERYDAY NEGATIVE STRESS  

Figure 3. Moderating effect of personal meaning on the physical health of older adults. 
In a related study of physically healthy California elderly, evidence for stress buffering was found using a life events inventory (e.g., death of a spouse). In this study, personal meaning was a buffer for perceived psychological well-being, but not for physical health. 
Finally, in a study of relatively healthy older adults, Underhill failed to find evidence for stress buffering.11 She did, however, find that personal meaning enhanced the levels of psychological well-being and physical health for both daily hassles and life event stress. 
Taken together, the research findings demonstrate that personal meaning plays a "dual" health-protecting and health-enhancing role. A high level of personal meaning not only shields one from the negative impact of stress, but also enhances ones level of wellness. 

SELF-ESTEEM :HOLOGICAL PHYSICAL 
.L-BEING WELL-BEING 14 
HI PMI (+1 SD) 40 40 12 
38 38 10 
36  36  LOW PMI (-1 SD)  8  
--::. ::.._:::__~:::.::: 
34 ""C  0  I I 10 20 30  34 ""C  0  -----,-._I • 10 20 30  6  0  __.____.__._ 10 20 30  
EVERYDAY STRESS  EVERYDAY STRESS  EVERYDAY STRESS  

Figure 4. The health -enhancing effects of personal meaning. 
Implications for Theory, Research, and Practice 
To date the specific mechanisms underlying the stress/meaning/health relationship have not been clarified. The mediating link may well be what I call creative coping, 4 one aspect of which is the process of cognitive restructuring. Cognitive restructuring refers to attempts to restructure, redefine, or reevaluate stressful situations in order to reduce their negative impact on health. It is a process of finding positive meaning in the situation; modification of attitudes, in logotherapy terms. Ways of finding positive meaning include seeing the side benefits of negative experiences, comparing oneself with others who are not doing as well, Imagining a worse alternative and feeling "lucky," adopting an attitude of acceptance, or constructing a better match between expectations and what is realistically possible. Thus, cognitive restructuring increases the individual's discovery of meaning. Individuals high in personal meaning may actively engage in any one or more of the above restructuring processes. Future research is needed to test this hypothesis. 
An important question not addressed in our cross-sectional studies is the direction of the meaning/health outcome relationship. Does a strong sense of meaning and purpose lead to a higher level of health, or does a high level of health influence one's sense of meaning and purpose in life? Prospective panel studies, in which the same individuals are assessed at several points in time, and/or experimental manipulations of engagement in meaningful activities and their effects on health outcomes, are needed to address this issue. 
What are the implications of our work for logoanalysis and logotherapy? One function of logoanalysis is to identify the level and sources of meaning so as to target the area toward which the search for meaning should be directed. This could be accomplished through the combined use of the LAP-R and the SOMP as screening tools. On the LAP-R, the existential needs of individuals can be profiled. Have they found meaning or are they actively searching for meaning? How deep is their existential vacuum? Do they have a sense of responsibleness and/or control over their life? Have they accepted the prospect of personal death? For individuals, who indicate on the SOMP that they have few sources of meaning and who are preoccupied with self-interests, meaning experience can be enhanced through the use of strategies that increase the number and variety of meaningful activities and by techniques that move them toward self-transcendence. 
The goal of logotherapy is to stimulate the will to meaning. The highest goal of most traditional therapies is the achievement of a fully integrated person, but they do little in moving the individual to a higher level of awareness. Logotherapy focuses on conscious experiences, accesses higher levels of consciousness, and is holistic by awakening the analytic and the creative sides of the brain. According to Eisenberg, logotherapy "restores health and hope by making people aware of the formidable power inherent in them, to stop feeling victimized, and take over control of their lives."1' P•57 Whether or not logotherapy has these effects can and should be tested empirically, using pre/post designs, the LAP-R, the SOMP, measures of health, and measures of hope or optimism. 
GARY T. REKER, PH.D., is a full professor in the Department of Psychology, Trent University, Peterborough, Ontario, Canada, K9J 788. As a life-span developmental psychologist, his research interests have focused on the aging process, particularly the role of personal meaning in wellness promotion. 
This paper is dedicated to his good friend, Dr. Arthur Underwood, who at the time of his writing, was engaged in a courageous battle with cancer. May he find meaning in his suffering and a sense of optimism to cope with his illness. 
References 
1. 
Eisenberg, M. (1982). Logotherapy--prescription for survival. International Forum for Logotherapy, 5, 67-71. 

2. 
Peacock, E. J., & Reker, G. T. (1982). The Life Attitude Profile (LAP): Further evidence of reliability and empirical validity. Canadian Journal of Behavioural Science, 14, 92-95. 


3. Reker, G. T. (1989, March). Operationalizing Frankl's logotherapy: Multidimensional measurements of the sources of personal meaning. 
Paper presented at the Meeting of the American Society on Aging, Washington, D. C. 
4. 
Reker, G. T. (1990). Creative aging: The power of years. Perspectives, 14, 

5. 
Reker, G. T. {1991, July). Contextual and thematic analyses of sources of provisional meaning: A life-span perspective. Invited symposium presented at the International Society of the Study of Behavioral Development {ISSBD), Minneapolis, MN. 

6. 
Reker, G. T., & Butler, B. (1990, October). Personal meaning, stress and health in older adults. Paper presented at the Canadian Association on Gerontology, Victoria, BC. 

7. 
Reker, G. T., & Peacock, E. J. (1981). The Life Attitude Profile (LAP): A multidimensional instrument for assessing attitudes toward life. Canadian Journal of Behavioural Science, 13, 264-273. 

8. 
Reker, G. T., Peacock, E. J., & Wong, P. T. P. (1987). Meaning and purpose in life and well-being: A life-span perspective. Journal of Gerontology, 42, 44-49. 


6-9. 
9. Reker, G. T., & Wong, P. T. P. (1983, April). The salutary effects of personal optimism and meaningfulness on the physical and psychological well-being of the elderly. Paper presented at the Western Gerontological Society, Albuquerque, NM. 
10. Reker, G. T., & Wong, P. T. P. (1988). Aging as an individual process: Toward a theory of personal meaning. In J. E. Birren and V. L. Bengtson (Eds.), Emergent theories of aging (pp. 214-246). NY: Springer Publishing. 
11. 
Underhill, S. C. (1991 ). Personal meaning and personal optimism: Interactive moderators of life event stress and daily hassles in older adults. Honours Thesis, Trent University, Peterborough, ON. 

12. 
Wong, P. T. P., & Reker, G. T. (1993). Profile of successful agers: Psychological, psychosocial, and living environment predictors. Unpublished manuscript, Trent, University, Peterborough, ON. 


ISSN 0190-3379 IFOOL 17(1)1-64(1994) 
The International •orua 
tor  
LOGOTHERAPY  
Journal of S•arc=h  for Ne1.11.b1.g  
The Ecoo Homo Technique: A Special Catie cl Oereflectlon  1  
James C. Crumbaugh and Rosemary Henrton  
The Element of Sul'prtse In the Logotherapeutlc Treatment  
or Adolescents  8  
Paul R. Welter  
Franldlan T1"8111ment with Traumatized Families  
Jim Lantz, encl Jan Lantz  

Finding Meaning In Uoovolclable Suffering 

Robert C. Barnes The Un!Verslty Department as e Base for Promoting the Study and Practice cl l.ogotherapy Kent Estes and Paul Wetter " Logotherapy In the Classroom ,, ._ Robert A. Wlsoo Adapting the Life Purpose Ouastlonnalre for Use with Adolescent PoplJations Robert R. Hutzell and WIiis C. Finck 
l.ogotheory and Logotherapy: Challenges, Opportunities, 
and Some Empirical Findings . 47 
Gary T. Reker 
Studem Paper Wlnnar3 at Wortd Congress In Toronto 56 
Revlaws 57 Recent Publications of Interest to Logotheraplsts 
61