SOURCE_DOCUMENTS/journal_020_1.txt

Viktor Frankl: Recollections--An Autobiography  1  
Book Review by Robert Leslie  
Experience With Logotherapy and Existential Analysis in a  
Hospital For Psychiatry, Psychotherapy, and Neurology  4  
Karl-Dieter Heines  
Nurse Structuring of a Logotherapeutic Milieu for  
Schizophrenic Inpatients  11  
Celia Wintz  

Logotherapy in Counselor Education: Important But Neglected 20 Kent Estes 
Finding Meaning Through Frankl's Socratic Dialogue and Fromm's Five Needs of the Human Condition: A Group Process for School Counseling 28 
Robert A. Wilson Addiction Recovery: Transcending the Existential Root of Relapse 37 Patricia E. Haines Meaning Levels and Drug-Abuse Therapy: An Empirical Study 46 
M". Angeles NOBLEJAS DE LA FLOR Logotherapeutic Aphorisms by Elisabeth Lukas 53 Book Review 54 Book Review 56 Recent Publications of Interest to Logotherapists 58 
Volume 20, Number 1 Spring 1997 
VIKTOR FRANKL 1905-1997 
Viktor Frankl was a prophet in the Biblical sense--a man who does not foretell the future but warns of its dangers. 
The main danger he saw for the human race was a life without meaning, the existential vacuum. As a philosopher, he thought and wrote about it. As a physician, he diagnosed it. As a psychiatrist, he prescribed logotherapy as prevention and cure. As an inmate of death camps, he tested it. As a human being, he lived it and served as a model. 
For each of us he has left a message of hope: that life has meaning under all conditions and that we have the capacity to find it, moment by moment, even in situations that seem hopeless; that we can turn tragedy into a human triumph; and that we can find meaningful attitudes even in meaningless situations. Frankl has assured us that we have the exclusively human dimension of the spirit, regardless of our religious or secular orientation, and that this dimension enables us to defy limitations in and around us, that "we do not have to take every nonsense from ourselves." He has encouraged us to pay attention, not so much to the causes of our difficulties but to ways to overcome them; to focus not on what is wrong with us but on what is right with us. 
For humankind on the whole, his prescription is vital for our survival in a life worthy to be called human. His insights are becoming recognized, but if we are going to survive under meaningful circumstances, perhaps even survive at all, the Franklian philosophy will have to be widely accepted in the next millennium. 
These insights include the call for a lifelong "education for responsibility," as he sometimes defined logotherapy. We have gained unimagined freedoms; but, as Frankl warned, freedom without responsibility brings not meaning but chaos, as can be seen from children having babies to irresponsible economic leaders and government officials. He recommended a Statue of Responsibility to balance the Statue of Liberty. 
He warned against nihilism (negation of meaning), reductionism (denial of spirit, bringing down everything to a material level}, collectivism (doing what others do), and fanaticism (insistence that our way is the only way). 
Frankl also prescribed, for a healthy society, a complete turnaround from how values are worshipped in the West--from a pursuit of power, prestige, money, and pleasure, to the pursuit of a meaningful life. Most people, he said, have enough to live on but nothing to live for. 
These are difficult demands, but it was Frankl's central message that meaning comes from responding to the demands of life. Life does not owe us pleasures and fair breaks, but offers us meanings which often come in the shape of suffering. From the laboratorium of the concentration camps came the lesson to ask ourselves, not "why me?" but "what can I do now?" "What can I learn from this pain?". 
He was the last surviving great European philosopher of this cruel century which he graced with his presence in almost its entire span. We are grateful for his presence. 
Joseph B. Fabry Robert R. Hutzell Vicki L. Hutzell 
FORUM SPECIAL EDITION 
Since Dr. Frankl's death, his family, and the Viktor Frankl Institute in Vienna, and our own Institute have been overwhelmed by such an outpouring of love and gratitude that we will devote a special edition of the Forum to the expressions of these emotions. Please send us brief essays of episodes, anecdotes, and memories of Viktor Frankl the teacher, counselor, and human being. Also include your photo and send your essay to the International Forum for Logotherapy, c/o Joseph Fabry, 315 Carmel Avenue, El Cerrito, CA 94530. Deadline is February 28 but earlier if possible. 
The International Forum for Logotherapy, 199 7, 20, 68-76. 
LOGOPHILOSOPHY IN THE THIRD MILLENNIUM 
Joseph Fabry 
The techniques of logotherapy will survive in some form for the benefit of individuals suffering from existential vacuum and its consequences. But what is even more important for humanity as a whole is the philosophy on which logotherapy 1s based. 
Western thought tends to see human beings as sinners who have to be saved, as animals that have to be trained, as machines that have to be programmed, as puppets that have to be manipulated, or as children who have to be told. Frankl, however, sees human beings as able to activate their best potentials, overcome their limitations, and choose meaningful actions or, where this is not possible, choose meaningful attitudes. He sees them as primarily motivated by a search for meaning; not by a striving for power, pleasure, and material wealth. 
Four of Frankl' s basic assumptions are especially needed for human survival in the third millennium. The first is that we are spiritual beings. Second, we are beings in search of meaning. Third, we are responseable beings, able to respond to the demands of life. And fourth, we are beings open to the Socratic kind of education. 
We Are Spiritual Beings 
As humans, we have the gift of a new dimension--not available to other animals--the gift of the human spirit which enables us to say No to the failures of our body, the urgings of our emotions, and the limitations of our surroundings. We also can say No to the pressures of peers and the dictates of authority. We can say No: but we have to take the consequences. The Biblical writers established this principle in the first chapter of Genesis. Adam and Eve said No even to God and ate 
68 
from the Tree of Knowledge, taking the consequences of being evicted from Paradise. 
Western religion interpreted Adam and Eve's disobedience to God as "original sin," that still bedevils our Western culture. Frankl would agree with the California theologian Matthew Fox who calls the expulsion from paradise the "original blessing." Adam and Eve were expelled from a world where its creatures were ruled by instinct; they were blessed to enter a world where they had the "defiant power of the human spirit" to take charge of their lives, even if it meant working by the sweat of their brows. We moved from animals to humans. 
But we were still children who had to be led by authority figures in order to survive in a world of dangers and scarcity. During the next few thousand years we mastered many of the threats and overcame scarcities. We evolved from the childhood stage of human development, and entered--if not maturity--at least adolescence. As every parent knows, adolescence means uncertainty, confusion, rebellion, depression, suicidal tendencies--all in evidence today, worldwide. 
Frankl's remedy is to draw attention to the resources of the human spirit. These are our will to meaning, our capacity to make choices and take responsibility for them, our ability to love others beyond the physical and emotional, our option to listen to our conscience beyond the commands of the superego, and, most of all, our capacity to "sniff out" the meanings life offers us moment by moment. 
Meaning 
One of the principal insights of logotherapy is that the goal of a fulfilled life is not power and pleasure but meaning. Having emerged from the jungle, we are obsessed still by the power struggle of survival. It is seen in political struggle, economic competition, individual fighting for wealth and prestige. Emerging from the childhood phase of humanity, we are obsessed still by the child's egocentric demands for pleasure and immediate gratification. 
Almost all our serious problems come from the idolization of power and pleasure. Within the family a power struggle fractures the old tribal ties when each member insists on "self-actualization" regardless of the needs of the other members. The schools prepare the young for a life of cut-throat competition in a society that considers power, prestige, and material wealth as its highest values. In our affluent, hedonistic society, the pursuit of happiness has been replaced by the pursuit of-no, the right to--immediate gratification. 
69 
Immediate gratification is seen in the credit-card economy of buynow, pay-later; the politics of tax-reduction now, a trillion-dollar-debt for our descendants. Immediate gratification is seen also in our insistence on having a high now--through sex, cigarettes, alcohol, and drugs-shortening, often ruining our later years. It is seen in the practice of using up irreplaceable resources and poisoning air, land, and water for present profits and enjoyment, never mind the future. 
Frankl's emphasis on the pursuit of meaning, rather than on power and pleasure, is not only a moral demand but also a prescription for survival. We are living through one of the great breaking points in history, perhaps the greatest and certainly the most perilous: from childhood to adolescence, from a vertical society where the guidelines for living came from the top of the social pyramid, to a horizontal society where we are challenged to find our own guidelines. 
We hear a lot about changing values: family values, traditional values, teenage values, baby-boomer values, "post-modern" values. But we have only the slightest notion how drastically the traditional and tested values of the past will have to be re-examined to be meaningful in the new age. 
The high value of power, production, and propagation was meaningful in a world of scarcity. Power was needed in a world where survival meant either you or me. But in a world of nuclear weapons a struggle for power leads, not to survival of you and me, but to the possible destruction of all. What we need today is not more power, but more tolerance and gentleness. The meek will indeed inherit the earth, or the powerful will destroy it. 
Production, in a world of scarcity, meant more goods and food in a starving world. But now, for the first time in history, a majority in at least part of the world is not hungry, and the rest knows that starvation no longer is unavoidable. People starve because others don't care. Production is progress, but uncontrolled production for pleasure and affluence is a major ecological threat. 
Having many children was necessary for survival of the human race. Now survival depends on limitation of the birth rate. 
Meaningful values that helped us overcome scarcity included frugality, sobriety, thrift, honest toil, self-denial, perseverance, obedience, loyalty, humility, courtesy, respect for tradition. These are still meaningful values not to be discarded lightly. But now the survival threat no longer lies in scarcity but in the possibility of total destruction in a world of plenty. 
70 
A new ethic is emerging, emphasizing such values as openness in personal relationships, hospitality, cooperation, tolerance, involvement, creativity, experimentation, spontaneity, participation, self-esteem, selfdetermination, self-transcendence, awareness of one's feelings and honesty in expressing them, consciousness, and most of all selfresponsibility in searching for a meaningful life. This does not mean that our traditional values are obsolete and have to be discarded. They are the condensed wisdom gained from the experiences of generations. But, at this breaking point from a vertical to a horizontal society, from a society that treats us as children, to a society on our way to maturity, established values have to be re-examined. 
Self-Responsibility 
Of all the new values, self-responsibility is the most challenging. We have become cognizant that life places demands on us to which we must respond, regardless of whether we see these demands in religious terms as coming from God, or in secular terms as coming from nature, ecology, or the tens of thousands of situations we face during our lifetime. We also have become cognizant of our ability to respond to these demands--our response-ability. 
It may be said, with some oversimplification, that the "meaning of the moment'" of the second millennium was the gaining of freedom. This was achieved by at least a sizeable part of humankind: political freedom --the democratization of the world; economic freedom--the abolition of serfdom and slavery; individual freedom--the abundance of choices in opinions and life styles. 
It may be permissible to state, again with some oversimplification, that the meaning of the moment for the third millennium will be the acceptance of self-responsibility. To be free has been the dream of humankind. But as Frankl has warned, freedom used irresponsibly does not bring meaning but chaos. He has suggested repeatedly that, as a symbol, we balance the Statue of Liberty on the East Coast with a Statue of Responsibility in the West. 
Americans take liberty for granted. They have, for the most part, achieved freedoms beyond anything their ancestors could have imagined. Yet, no paradise has arrived. We are free to make all sorts of choices, including irresponsible ones. The suffering masses of the poor, homeless, and starving are growing. In different ways, the rich suffer-from boredom, emptiness, and frustration. They hunger not for food but for meanings. They have plenty to live on, but don't know what to live for. 
71 
We are rightly proud of the first amendment. But, as Justice Oliver Holmes warned, freedom of speech does not include shouting fire in a crowded theater. Neither does freedom of assembly include incitement to violence; nor freedom of the press, slander and pornography; nor freedom of religion, hateful fanaticism. 
To learn how to use our newly-won freedom responsibly is perhaps the greatest challenge as we grow to adulthood. It is no exaggeration to say that humans may become an endangered species, and all life on earth may become endangered, unless people find self-responsibility to an extent unimaginable, even unacceptable, now. 
The irresponsible use of freedom is the cause of the three mortal dangers our generation faces--atomic war, pollution, and overpopulation. We produce atomic weapons because technology has given us the freedom to produce them. Ecological destruction is possible because everyone, individuals and corporations, feels free to seek comfort and affluence at the expense of the environment. And we have the freedom to give or control birth. 
Colonialism was stifling freedom. Communism was oppressive. But when colonialism and communism were lifted, the irresponsible use of the newly-won freedom resulted in millions being killed, ma,med, and starved when tribes, ethnic units, religions and sects were fighting each other. 
On a much smaller scale, freedom without responsibility allows people to blare loud music from open cars, litter beaches. spray slogans on walls, seek frivolous divorces, organize hate demonstrations, sell pornography, and terrorize abortion clinics. In the name of freedom the bastion of the meaningful life--the family--is fractured. Teenagers have children, adults leave their spouses, and old parents are abandoned in nursing homes. 
Limitless freedom, often misinterpreted and idolized, gives everyone rights which authoritarian societies held in check. Small children are given the "right" to intimidate adults, learning the wrong lesson for their later lives. High-schoolers demand the right to advance to the nexthigher grade even if they did not acquire the proper knowledge; or they drop out altogether, limiting their later freedom to find remunerative jobs and satisfying careers. Teenagers assume the right to smoke, use drugs and alcohol, and have sex. Adults claim the right to self-actualization, lllll regardless of the consequences for others. Fanatics who do not allow others the freedom to disagree are granted the right to preach, publish, and live hate. People, from high government officials to welfare recipients, feel free to cheat and lie as long as they are not caught. 
72 
The USA is a free country, and an example for the rest of the world. Now we have to become a responsible country, to be the example for a peaceful world. 
Education 
Frankl' s prescription for a cure consists of one word: education. It is preventative medicine, requiring a turn-around in our traditional view of education. 
Education would still center on passing of information. But it would include also character eduction, value education, and, most of all, education to responsibility. 
Americans resist "teaching values" in schools. But the disarray of the family and the deterioration of the moral stance of our youth make the benefits of a value-free education questionable. In a 1994 Gallup poll, 71 percent of Americans said it is more important for schools to teach values than to teach academic subjects. Another poll, also in 1994, conducted by the teacher's magazine Phi Delta Kappa, found that 49 percent of Americans favored courses on values and ethical behavior. 
Here Frankl has guiding thoughts. Children have to be led to finding their authentic selves. To grow into responsible adults, they have to be aware that their spirit contains a healthy core that remains healthy even when they are sick. Their spirit is not depressed when they are depressed, and not afraid when they are afraid. They have to learn that it may be necessary sometimes to postpone instant pleasure to attain meaning later; and 1n their struggle for material things, they may have to consider the needs of others. 
Frankl's ideas of education go back to Socrates, who believed that, deep within, we know what is good and true. It is the primary job of the teacher, not to pour information into students, but to draw out of them what intuitively they know. This is education in the original sense. Educere: to draw out. 
Parents and other role models are, of course, the principal teachers. If children learn in school to lead meaningful lives, and come home to a family that is power-and pleasure-oriented, they likely will follow the example of their parents. It will take generations until the children grow up with parents who themselves have had a value-oriented education. 
What will be the curriculum? In order to prepare children for a life in which meaning has high priority, education will have to liberate us from the dangerous trends which Frankl has identified as the enemies of the meaningful life: nihilism, pan-determinism, reductionism, fatalism, 
73 
conformism, and authoritarianism. Nihilism is the belief that life has no meaning. Pan-determinism claims that we are completely determined by forces beyond our control: genes, emotions, environment. We must show our children that these forces beyond our control, while influential, are not all powerful. Reductionism sees human beings only on the psycho-physical level or, worse, as computers. Reductionist values are subhuman: trainability, cost efficiency, productivity, replacability, predictability, measurability. Fatalism is the belief that our life is preordained. Conformism and authoritarianism are the results of having lost faith in traditional guidelines, so we do what others do or we follow a leader. 
But this is only the beginning. Education will have to awaken in children a sense of self-chosen accountability, commitments, an awareness of potentials, and the strengthening of character. The traditional three R's of education--reading, writing, and 'rithmetic--will have to be extended by a fourth R--'racter, as in cha-racter. Character, values, and meaning-orientation will be subjects that will have to permeate a school's academic activities. 
Character education will have to tell children that some things are right or wrong under all circumstances: to be honest with facts; to treat others with respect; to be orderly, clean, trustworthy, caring, responsible for actions and inactions, just, helpful, tolerant; and to take part in the activities of our community--from our family to our neighborhood, church, village, country, world. 
Values have been taught in all societies. The Bible lists "fruits of the spirit": love, joy, peace, patience, kindness, generosity, faith, mildness, and self-control. The ancient Greeks list "cardinal virtues": prudence, courage, temperance, and justice. 
Educators today, apprehensive about using the term "values," speak of "life skills," practical qualities that serve as take-off points to a meaningful life. Among them are integrity (to be sincere), flexibility (to do things that need to be done), perseverance (to continue in spite of difficulties), organization (to plan, arrange, and implement in an orderly way), effort (to try hard), common sense (to use good judgment), problem solving (to seek solutions in difficult situations), responsibility (to be accountable for actions and inactions), patience {to wait calmly for someone or something), friendship (to trust and care for someone), lllllll curiosity (to find out about a full range of things), cooperation (to work together toward a common goal), caring (to feel concern for others), courage (to be willing to take risks), and sense of humor (to laugh and be playful without hurting others). 
74 
The new curriculum will have to give children a chance to participate in discussions; not to compete but to understand others. Church school classes will have to expose children to other religions; not to convert them but to understand their beliefs. 
Two of Frankl' s concepts will have to be high on the curriculum from nursery age on. Children will have to be made aware that they have the defiant power of their spirit, which enables them to resist their natural urges and peer pressure; and self-transcendence, their ability to reach out to others and help them, which will trigger a spiral of positive responses. 
The whole structure of schools will have to be rethought. Classrooms will not be ruled by competition but cooperation. Students who are talented 1n a subject will help others who have difficulties with it. Teachers will draw attention to what's right with a student, not what's wrong. This is a beginning but by far not enough. The next step would be to select appropriate material in all classes. But this, too, is only a small step. 
It is not enough to expose children to what the sages of the ages have found to be true. Their thoughts must be used as springboards for discussions by the children about their experiences, thoughts, and feelings. These classes will take on the form of encounter groups; not to vent hostility, but to share thinking and emotions. 
Among educators already using logotherapeutic ideas is Robert Wilson, director of psychological services in the Fresno Unified School District in California. He has worked out an elaborate method for helping Junior high-schoolers discover value and meaning in their lives. He uses newspaper and magazine articles, fables and stories, life experiences offered during field trips, and guest speakers, to spark open-minded, non-judgmental discussions on questions that concern the pupils in an effort to help them find their own answers. (See International Forum for Logotherapy, 17, 1). 
Wilson's teachers use the Socratic dialogue to probe the five areas where meaning is most likely to be found: discovery of their authentic selves, awareness of their choices, their uniqueness, responsibility for their actions, and self-transcendence. Wilson uses lists of simplesounding questions that explore these five approaches to meaning, and help students face their hopes, fears, thoughts, and emotions. He has four evaluation scales: self-perception, values, character, and meaning. Students can scale their answers (to such statements as "I like myself," or "making choices is easy for me") from 1 to 4 (never, sometimes, often, always). 
75 
It will take much time and effort to convince school boards, parents, and administrators to accept such meaning-oriented teaching methods as part of the curriculum. Providing students with the skills to get wellpaying jobs is only part of the task. Schools in the third millennium will have to prepare students to get meaningful jobs in a world where a meaningful life is possible. 
One doesn't exclude the other. Students who have gone through Wilson's educational programs have gained insights about themselves and their classmates; they have become more understanding of others, more tolerant, and self-assured. As a significant bonus, their grades have gone up; their dropout rates, violence, and addictive habits have gone down. 
Perhaps the most important sentence in Frankl' s philosophy consists of seven words: Humans are beings in search ofmeaning. The meaning must be found not in self-centered competition but in consideration of others. 
Conventional wisdom will say this is against human nature; that we are selfish, emotion-driven, competitive, and evil. Perhaps this is true, and these qualities were necessary for survival in the jungle world of scarcity. But now we live in the self-made jungle of affluence in an atomic age. Frankl's wisdom points to our dimension of the human spirit that can lift us beyond selfishness, emotions, cut-throat competition. and evil behavior. We have a choice between our evil potentials and our good potentials; we can choose self-transcendence, common sense, cooperation, and decent behavior. 
Not only our lives depend on it, but the life of the planet. 
JOSEPH FABRY [315 Carmel Avenue, El Cerrito, California 94530 USA] 
is Founder and President Emeritus of the Viktor Frankl Institute of Logotherapy and Co-editor of the International Forum for Logotherapy. This article is based on his presentation at the Fall Conference of the Mid-America Institute of Logotherapy in Kansas City, November 2, 
1996. 
76 
The International Forum for Logotherapy, 1997, 20, 77-79. 
TEACHING CHILDREN PEACE-MAKING SKILLS 
Florence I. Ernzen 
In a world of people fighting for resources, relationships, or territory, and our local communities threatened by violence, it seems helpful to teach peace-making skills to children, beginning with children in kindergarten. 
I follow six steps in teaching the skills of peace. The format I have used for the past five years is also applicable to educating families, individuals, and groups. 
•We 
need to recognize that conflict is in our lives. Conflict is a part of lite. It can be positive if we talk about our differences and learn new and better ways to respond to problems. Problems can be opportunities to learn something new. 

•We 
have conflicts because we are not all alike. When I work with children, we talk about the uniqueness of each human being. Each person is unrepeatable. We celebrate our uniqueness and that of children everywhere. We share in games, art, and language of children from other countries. We begin our activities with compliments. These compliments build a sense of community and connection in the classroom. 

•If 
we are to be effective peace-makers, we must learn to understand feelings. We learn to name feelings and to distinguish our feelings from what we feel like doing. This is a hard concept. A child might say, "I felt like hitting him." We help children distinguish the feeling of anger, frustration, or vulnerability from how they wanted to react. We explore ways to respond that promote friendship and good will. We know that feelings are at least as important as the issue that caused the conflict. We encourage respect for our own feelings and the feelings of others. 

•We 
know that a person's ability to communicate clearly significantly improves conflict resolution. We teach even very young children how to construct an "I" message. We know when people use "You" messages we feel threatened and try to defend ourselves. Whereas "I" messages tend to be heard and promote understanding. An "I" message has four parts: I feel (state the feeling), when you (describe the behavior), because (consequence of the behavior), and I want (what would make the situation better for you). This may sound very simplistic, but I have seen it work magic. For example, a first grade girl stated to her class, I feel upset when you call me Hell, short for Helen, and I would like you to stop. The class never repeated this insult. 

•We 
teach children to listen to others. Listening gives information and diffuses anger. We need to model good listening habits for children. They can tell you how they know if adults are listening to them. They enjoy doing listening activities that are part of various peace-making programs. Through these activities they begin to embrace the skills to use in resolving conflicts. 

•The 
final step is to learn to resolve conflict. Children are taught to agree not to interrupt, call each other names, and to agree to work on the problem. These are in essence the same ground rules used in all mediations. They are taught to look for options; these might include taking turns, walking away, asking for help, etc. I have found children to be very kind, self-transcendent, and willing to resolve issues simply while adults are busy looking for someone to punish or blame. 



77 
Peace-making skills are lifetime skills. The future lies with people who are able to work confidently and cooperatively with one another. Peace-making skills are infinitely practical and yet they call on the rich resources of the human spirit. They help us to de-reflect, to gain a new perspective on our values and the values of others. Peace-making skills help us exercise our ability to choose and to choose wisely to build up relationships, to strengthen our communities. These skills help us develop as responsible, caring human beings. Elisabeth Lukas tells us logotherapy increases hope in the world, our work must transcend out into the world. We must reach more than the patient. We must choose a new potentia, a new possibility. Teaching children to be peace-makers increases our chance for survival in the new millennium. 
78 
Peace-Making Resources 
Conflict Resolution: Elementary and Secondary School Curriculum. 
The Community Board Program, Inc., 2540 Market St., #490, San Francisco, CA 94102. 4151552-1250. 
Creative Conflict Solving For Kids. Friedman, Alice and Schmidt, Grace Contrino Abrams Peace Education Foundation, 1900 Biscayne Blvd., Miami, FL 33132. 800/749-8838. 
Getting to Yes: Negotiating Agreement Without Giving In. Fisher, Roger and Ury, William. Penguin Books, New York. 
Teaching Tolerance, a journal for educators. Write to Teaching Tolerance, 400 Washington Ave., Montgomery, AL 36104. 
FLORENCE I. ERNZEN, MSW, ACSW [46461 Arboretum Circle, Plymouth, Michigan 481 70 USA], Diplomate in Logotherapy, is a School Social Worker in Wyandotte, Michigan and Logotherapy Trainer. 
79 
The International Forum for Logotherapy, 199 7, 20, 80-84. 
CONVERSATIONS WITH TERMINALLY ILL PATIENTS 
Leo Michel Abrami 
Most of the terminally-ill patients I have interviewed have seemed quite anxious about the value and meaning of their entire career as human beings. The following example is an illustration of this type of existential concern. 
Joe, a retired professor of law from New York, was in Intensive Cardiac Care. He was full of anxiety when his son left his room that afternoon.. He had just signed a document stating that he should not be resuscitated if his heart should stop beating. It was as if he had just surrendered his claim on life, and for the first time ever he was afraid of dying. 
We got acquainted, and at my request he agreed to tell me about himself and his career. He had always wanted to be a man of law, and he had endeavored to fulfill his dream. In the course of his career, he had been called upon to write some important pieces of legislation, including the one establishing the legal status of the foreign personnel ot the United Nations. I told him that his valuable contribution must have been appreciated by many. He asked: "Do you think it was really worthwhile?" I was nodding in the affirmative when he added: "My son doesn't think so." I immediately replied that I thought his son was wrong, and that he would probably not be an attorney today if he had not admired his father's dedication to the legal profession. In order to comfort him, I hastened to add: "If I had known you in my student years, I might have studied law under your guidance." He smiled and thanked me for my kind words. 
80 
This man needed to be reassured not only about the intrinsic value of his professional accomplishments, but about an even more awesome question which he had asked himself often: Have I accomplished what I ought to have done in my life? Have I fulfilled my human vocation? 
When I told him that only he--and not his son--knew in his heart the answers to these questions, he regained his jovial countenance and said: "I have always known that this was really what destiny expected me to do in life." 
This question seems to be present even when we are not aware of it. It underlies some of the other concerns we have about the worthwhileness of some of our endeavors. We experience the need to feel that we have done our best to fulfill the ultimate meaning of our life, but no one besides us can give us the answer to that question. The counselor may therefore use the Socratic dialogue to help patients find the answer to that awesome question which they are not always able to formulate explicitly. This delicate situation reminds us of the story of King Nebuchadnezzar who demanded with insistence that his wise men help him remember the dream he had forgotten, and then interpret it. 
Every question about meaning in general is tied up to the question of ultimate meaning. When Dr. Frankl asserted: "Say yes to life," he meant more than that we should stay alive, he meant that we should be true to ourselves and fulfill that ultimate meaning which only we can fulfill. It is part and parcel of our personality, it constitutes our human vocation. 
The task of the counselor is to help the counselees come to validate what has been meaningful in their lives. A kind word may convey the reassuring message that the search is legitimate and that the discovery is at hand. When the patients have succeeded in finding the answers, they will be able to regain a sense or worthiness and, eventually, peace of mind. The following cases, selected from interviews with terminally ill patients, illustrate this process of reassurance and validation, even when the patients can barely speak at all. 
81 
As I came to visit Rachel, her private nurse informed me that she would not talk or even open her eyes. I took her hands and I said: "Rachel, i am your friend Leo." She then opened her eyes and said: "I am so glad you came." We reminisced for a while and I said: "Rachel, I remember the wonderful fund-raising parties we had at your home and I am looking forward to the next one." We both laughed and I then said: "I express to you my gratitude for your devotion to the wellbeing of our community and the substantial contributions you made to our favorite charities. The world would not have been the same without you. Your efforts made the difference. God bless you." She smiled, squeezed my hand, and died peacefully a few moments later. 
Sam was a man who had suffered a great deal in the last few years: his only son had been killed in a tragic accident, his wife had died after a long illness, and he was now in the 
terminal phase of an unforgiving disease. I said to him: "Sam, I admire you for your courage and moral strength. You have proven that you can bear pain with dignity. You had to face so many trials and you did not complain once. I don't think I could have done it." He indicated with a motion of his hand that he had heard my words, and he slipped back into silence. 
Ruth had suffered a heavy stroke and lay in a coma. I sat down next to her and said: "We miss you dearly. You have been such a stronghold and an inspiration in our community. We are grateful to you for the example you set for .us. You certainly 
fulfilled your vocation with honor." As I began to recite the 23rd Psalm, I beheld the movement of her lips. She was praying with me.. 
It 
82 
In order to be guided in my conversation with those still able to express themselves, I have conceived the following questionnaire which has proven useful in interviews with terminally ill patients: 
ASSESSMENT OF A LIFETIME EXPERIENCE 
1. 
Looking back over the years, how would you describe your most significant achievements in life? 

2. 
What are some of the other contributions you made during these years? 

3. 
What were some of the important decisions you had to make in order to achieve these results? 

4. 
What motivated you to pursue these goals? 

5. 
In the final analysis, to what do you attribute your success? 

6. 
In what way do you think that chance played a certain role? 

7. 
In what way do you think that destiny or providence guided your undertakings? 

8. 
What experiences brought you joy and satisfaction in life? 

9. 
Were you aware of the ultimate meaning of these undertakings? 

10. 
What could you have done to enjoy life more fully? 

11. 
What were some of your failures in life (e.g., missed opportunities, professional or vocational goals, relationships gone sour with family, friends, or colleagues)? 

12. 
To what do you attribute these failures? 

13. 
How could you have avoided them? 

14. 
Did you enjoy being creative in your career? 

1
5. What significance did you assign to creativity? 

16. 
What were your dreams for the future when you were young? 

17. 
When did you decide to realize these dreams? 

18. 
Did you ever experience the feeling that you were at the right place at the right time on certain propitious occasions? 

19. 
Did you ever think that you had a particular vocation or calling to fulfill in life? 

20. 
To what extent were you able to fulfill this calling? 


21 . Do you think that your contribution made a difference in the world around you, that it left an impression on some people? 
22. 
Do you think that you exercised some influence on at least one person in your lifetime? 

23. 
Have you ever had an experience of true friendship? 

24. 
Have you ever had an authentic love experience (platonic, filial, or sexual)? 

25. 
Have you ever had a peak experience, a feeling of high exaltation, a mystical experience (unio mystical? 

26. 
What are some of the sublime memories that stand out? 

2
7. In what way were(are) you better than your parents? 

28. 
Do you think your parents achieved their goals? 

29. 
What do you think your spouse and your children learned from you? 

30. 
Do your spouse and children know how much you love(d) them? 


83 
31 . What would you like to say or write to them at this time? 
32. 
If you had to start a new life all over again, what would you emphasize or leave aside in you way of life? 

33. 
Of the "unfinished business" you have left, what would you try to complete first, if you had a chance? 

34. 
Do you think you have a certain duty to do so? 

35. 
Do you think that people appreciate(d) you for your intelligence, your talent, success, reputation, charm, kindness, generosity, wealth, or physical appearance? 

36. 
Do you think that people recognized your true qualities? 

3
7. What would you tell your friends and your acquaintances about the meaning of your life, or human life in general? 

38. 
What are some of the life's secrets that you have come to understand? 

39. 
When you come face to face with God (or Destiny), what will you say? 

40. 
What do you think God (or Destiny) might tell you? 

41. 
What causes you regret? 

42. 
About what do you feel guilty? 

43. 
Do you think you fulfilled your calling or vocation in life? 

44. 
Do you think your life was worth living? 

45. 
How would you like to be remembered? 


LEO MICHEL ABRAMI (3840 Brayton Avenue, Long Beach, California 90807 USA] is a psychoanalyst (in France} andpart-time lecturer in the Department of Religious Studies, California State University, Long Beach. 

84 
The International Forum for Logo therapy, 199 7, 20, 85-94. 
MEANING-CENTERED COUNSELING: A COGNITIVEBEHAVIORAL APPROACH TO LOGOTHERAPY 
Paul T. P. Wong, Ph.D. 
(ABSTRACT) This paper is the first ofa series ofpapers that extend Dr. Frankl's pioneer work of bridging between existential traditions and cognitive-behavioralpsychology. Meaning-Centered Counseling may be regarded as neo-logotherapy, because it translates and extends the basic tenets of classic logotherapy into cognitive behavioral processes. Such an effort is intended to facilitate and broaden scientific research on the role of personal meaning as well as the efficacy of logotherapy. 
The days for schools of psychotherapy seem to be over, because an increasing number of therapists are adopting an eclectic and integrative approach. However, a case can be made that specific schools of psychotherapy are going to stay, because they provide a unique set of conceptual and therapeutic tools from which an eclectic therapist can draw. Knowing how to employ a variety of intervention skills does not necessarily make one a competent therapist. Effective counseling 

depends on case conceptualization and a treatment plan, both of which need to be informed by some theory of psychotherapy. The longevity of each theory depends on its ability to incorporate creative ideas and recent research findings to meet new challenges facing therapists and counsellors. 
Meaning-Centered Counseling evolves from existential therapy to the extent that it addresses universal existential concerns, such as meaninglessness, death anxiety, etc. However, Meaning-Centered Counseling may be more accurately regarded as neo-logotherapy, because it embraces the basic tenets of classical logotherapy and adopts a more cognitive-behavioral approach. 
85 
Although Viktor Frankl has been recognized by some as a forerunner of cognitive-behavioral therapy,4 •5·6 he has not been given due credit for being the first person to bridge the gap between existential psychotherapy and cognitive-behavioral theories. Given my background in cognitive-behavioral psychology,8•12 it is natural for me to extend the pioneer efforts of Frankl in this direction. 
One of the common criticisms of existential psychotherapy is that it is too vague and philosophical and that it is based on insight rather than scientific research. To overcome these deficiencies, MeaningCentered Counseling attempts to translate philosophical propositions of existential psychotherapy into cognitive-behavioral principles, so that empirical research can be conducted to test the model. 
Definition of Meaning 
What do we mean by meaning? We need a comprehensive operational definition in order to facilitate research and communication. I have conducted a series of studies on people's implicit theories of meaning of life.10 This research program identifies three defining components: cognitive, motivational, and affective, as depicted below. 
Cognitive 
(beliefs, schemas, making sense) 

Emotional  Motivational  
( feeling good,  (goal striving, purpose,  
feeling alive)  incentive value)  

Figure 1. Defining Components of Meaning 
86 
The cognitive component is comprised of beliefs, schemas, and expectations; it includes all the cognitive processes that help people make sense of the world. It enables people to predict and explain events and personal experiences and give them a sense of coherence. It also facilitates the choice of a particular life goal. If I believe that my destiny is to be a musician, then I will be willing to endure suffering and poverty to be what I am meant to be; life would be meaningless and unfulfilling if I were to choose a different path. I believe, therefore I exist. I hope, therefore I strive. I expect, therefore I act in certain ways. In sum, I am what I think. This cognitive component evolves out of past life experiences and cultural imperatives, and it forms the foundation of meaning structures. 
The motivational component primarily consists of goal setting and goal striving behaviors. Motivation manifests itself in choice, persistence, and other goal-related behaviors, but stems from cognition. Our core values determine our priorities and purpose in life. We tend to invest time and energy in projects to which we attach value and significance. Values are deeper than attitudes; they reflect our fundamental beliefs, world-views, and cognitive schemas. Therefore, our goal setting and goal striving are dictated to a large extent by what we think. Meaning is actualized from both the attainment of goals and the pursuit of goals that are consistent with our beliefs and value systems. If cognition is the cornerstone of personality development; then motivation is the engine and the fuel that moves us forward toward our destiny. 
The affective state of feeling fulfilled or feeling good about one's life comes from two sources--beliefs in the significance of life and the actual pursuit of a worthy goal. It is an inevitable outcome of synchronization between positive thinking and purposeful living. For example, if a person believes that his calling is to serve God, and he dedicates his life to the Christian ministry, then feelings of fulfillment should stern from pursuing his vocation. Emotion serves as a barometer of the degree of meaningfulness. 
How do we know whether we are living a meaningful life? According to the present analysis, all three components must be present--having a set of positive beliefs about one's life, pursuing what one really wants in life, and feeling good about the way life is unfolding. 
In terms of structural components, personal meaning may be defined as an individually constructed and culturally based cognitive system, 
87 
which influences the pursuit of activities and life goals. Positive beliefs and purposeful living inevitably endows life with a sense of significance and fulfillment. 
Meaning systems are highly idiosyncratic, because they are largely the product of unique personal histories and mental makeup. What is meaningful to one person may be trivial to others. For example, those who have lost loved ones during the war may value a faded family photo more than any other possession. 
Yet, one of the propositions of Meaning-Centered Counseling is that it is not possible to understand personal meanings apart from culture. Through the process of socialization, values and beliefs are transmitted to individuals. One's perceptions, cognitions, and behaviors are necessarily colored and shaped by the cultural context in which one grows up. Ivey, et al. maintain: "Almost all clients of any cultural background will bring problems related to meaning. Since the definition of meaning sometimes depends on the religious, ethnic, and cultural background of your client, you need to be prepared to deal with a variety of meaning and belief systems ranging from Christian and Jewish to Mormon to Islamic. ' P-314 Therefore, cross-cultural
"5 understanding is of vital importance in Meaning-Centered Counseling. 
The Basic Postulates of Logotherapy 
The fundamental assumptions of logotherapy are presented in Figure 
2. This second meaning triangle explains why logotherapy is "therapy through meaning." The Freedom of Will proposition states that individuals always have the freedom to choose a positive attitude, even in the most appalling conditions. This assumption affirms the existence of a healthy inner core and the operation of an indomitable human spirit. 
Freedom of choice is one of the basic propositions of existential/humanistic tradition, but it is logotherapy which emphasizes the therapeutic imperative of recognizing one's capacity to choose. Even in extreme situations, there are a minimum of two options: to give up or to fight. However, ,n most situations, there are several alternate courses of action. Meaning-Centered Counseling almost always asks clients about the cognitive and behavioral options available. Once clients are made aware of these alternatives, they are then guided through an exercise to choose the most responsible and meaningful option. This Ill exercise includes thinking through the consequences of each decision and helps the clients make the most meaningful decision. 
88 
Freedom of Will 
(free to choose an attitude towards conditions oflife) 

The Meaning of Life The Will to Meaning 
( can be found in any situation) (motivated to find meaning) 
Figure 2. Fundamental Assumptions of Logotherapy 
The Will to Meaning oroposition assumes that there is a universal, primary motivation to find meaning. But, if the quest for meaning is universal, why is it that so many people seem to be so busy with the business of daily living without ever expressing a yearning for meaning? Why do so many people simply enjoy the pleasure of the moment without showing the slightest interest in the weighty questions about life's meaning? 
The answer is that the Will to Meaning is a latent motivation, which is often suppressed by survival instinct, the pleasure principle, and the will to power. But when all the things and people that sustain us are taken away, the Will to Meaning often comes to the fore; because without meaning, life would be too painful to endure. The quest for meaning may also be aroused by a spiritual awakening, or a turning point in life, when we realize that we can no longer continue living in the same direction. The need for meaning may be unconscious, or latent, but it is always there. The purpose of logotherapy is to facilitate clients' quests for meaning. 
89 
According to Meaning-Centered Counseling, the Will to Meaning entails more than the need to discover meaning--it also includes the motivation to construe and create meanings. In short, the Will to Meaning consists of three primary needs for meaning, which can be met by different cognitive and behavioral processes: 
• 
The need to make sense of human existence--"What is the meaning of human existence?" This is the need to discover ultimate meanings of life through higher cognitive processes, such as reflection, introspection, meditation, and spiritual beliefs. This motivation renders the incomprehensible mysteries of life more coherent and comprehensible. 

• 
The need to make sense of events--"What is the meaning of my experiences? Why do bad things happen to me? Why me? Why now?" The need to construe specific meanings can be met through perceptual and cognitive processes, such as causal attributions and cognitive schemas. This motivation reflects the need to reduce a complex and sometimes disturbing array of events into more predictable and controllable patterns. 

• 
The need to create meanings--"What is the meaning of my daily life? How can I live a meaningful and fulfilling life? Since life is so short, how should I live?" The need to create personal meanings, not arbitrarily, but based on a person's past and hopes for the future, can be met through commitment, activities, and validation. Validation means affirmation or reinforcement of one's pursuit as being worthwhile and significant. This motivation enables one to experience daily living as being meaningful. 


90 
Meaning-Centered Counseling attempts to address these three primary needs for meaning, as illustrated in Figure 3. These needs are universal because they are rooted in human nature. Human beings are the only meaning-seeking, meaning-making creatures. Meanings are, in many ways, more real and intimate to us than objective reality. What affects us most is not actual events, but our interpretation of these events. We live and operate in two worlds--the world out there, and the world within; 1t is the inner reality that matters most. The primary focus of Meaning-Centered Counseling is in the realm of meanings. Whatever changes clients want to make in their lives have to begin with changes in attitudes and meanings. This is followed by appropriate behavioral changes, which may or may not involve environmental changes, such as job change or relocation. 
Construe Meaning 
(through cognitive processes) 

Discover Meaning  Create Meaning  
( through reflections)  (through activities)  
Figure 3. Primary Needs of Meaning  

The Meaning of Life proposition assumes that meaning can be found even in the harshest life situation. Frankl proposed three basic avenues to find meaning, as illustrated in Figure 4.1•3 This figure is adapted from Wilson' and is self-explanatory. 
91 
Attitudinal (how I view life-accepting what cannot be changed, being positive about what can be changed) 

Experiential Creative 
(what I take from life(what I give to lifeexperiencing the joy making a difference of living) in the world) 
Figure 4. Frankl' s Ways to Find Meaning 
My own research on implicit theories has identified seven major sources of personal meaning: achievement, relationships, intimacy, selftranscendence, self-acceptance, fair treatment, and religion. 10 I have demonstrated that Frankl' s three avenues can be applied to each of the seven sources, resulting in 21 ways of finding meaning.9 I will report more details in the second paper in this series. 
!n the present paper, I have shown that the basic tenets of logotherapy can be translated into cognitive-behavioral processes. The basic principles of Meaning-Centered Counseling can be represented by a set of four overlaying meaning triangles as shown in Figure 5. 
These triangles suggest that meaning-oriented therapy needs to be grounded in a proper understanding of the components of personal meaning and the basic postulates of human nature. It also needs to be built upon the knowledge of the cognitive-behavioral processes involved in meeting primary motivational needs for meaning. The application of Ill specific interventions can benefit enormously from such basic understanding and knowledge. 
92 
Attitudinal 

Freediim 
. orwm\_ 

Will to \ Meaning ·.. _ Dii1cover '· · 
· ·· ·· ·· · · · · · · · · .-.. Create-. _.·1\leaning Meaning·... 
~ricntial APPLICATIONS Creative 
Figure 5. Basic Principles of Meaning-Centered Counseling 
Conclusion 
Meaning-Centered Counseling is a hybrid of existential-humanistic transitions and cognitive-behavioral developments. it is a natural extension of logotherapy. By translating the basic tenets of logotherapy into cognitive-behavioral processes, Meaning-Centered Counseling hopes to promote systematic scientific research on the role of personal meaning as well as the efficacy of logotherapy. 
Meaning-Centered Counseling empowers clients to find positive meanings and act on them. The main objective of Meaning-Centered Counseling is not so much problem-solving as fulfilling the basic need for meaning. The therapeutic goals of Meaning-Centered Counseling are: a deeper understanding of the problem, a higher level of self-knowledge. a clearer sense of life goals, and a workable plan for desirable changes. These goals are accomplished by applying a variety of cognitivebehavioral interventions.11 
Fabry has raised a poignant question: "As our century ends; the world is in chaos. Religious conflicts, national struggles, trade wars, cutthroat competition. ecological disasters, crime waves, family breakups--what can put sapiens back into homo?"2• P· 7 The study of 
93 
personal meanings may be an important first step towards finding the right answers. 
PAUL T. P. WONG [Trinity Western University, 7600 Glover Road, Langley, British Columbia V2Y 1Y1, Canada) is Director of the Graduate Program in Counselling Psychology at Trinity Western University. 
References 
1. 
Fabry, J. 8. (1968). The pursuit of meaning: Logotherapy applied to life. Boston: Beacon Press. 

2. 
Fabry, J. B. (1995). Prescription for survival. The International Forum for Logotherapy, 18, 7-12. 

3. 
Frankl, V. E. (1959).Man'ssearch for meaning. NY: Pocket Books. 

4. 
Frankl, V. E. (1985). Logos, paradox, and the search for meaning. In M. J. Mahoney & A. Freeman (Eds.), Cognition and psychotherapy (pp. 259-297). NY: Plenum. 

5. 
Ivey, A., Ivey, M., & Simek-Morgan, L. (1993). Counselling and psychotherapy: A multiculturalperspective. Boston: Allyn & Bacon. 

6. 
Mahoney, M. J., & Freeman, A. (Eds.) (1985). Cognition and psychotherapy. NY: Plenum. 

7. 
Wilson, R. A. (1997). Finding meaning through Frankl's Socratic Dialogue and Fromm's five needs of the human condition: A group process for school counseling. The International Forum for Logotherapy, 20, 28-36. 

8. 
Wong, P. T. P. (1995). A stage model of coping with frustrative stress. In R. Wong (Ed.), Biological perspectives on motivated activities (pp. 339-378). Norwood, NJ: Ablex Publishing. 

9. 
Wong, P. T. P. (1995, July). Sources ofpersonal meaning across the life-span. Paper presented at the Tenth World Congress of Logotherapy, Dallas, TX. 

10. 
Wong, P. T. P. (in press.a). Implicit theories of meaningful life and the development of the Personal Meaning Profile (PMP). In P. T. P. Wong & P. Fry (Eds.), The human quest for meaning: A handbook of psychological research and clinical applications. Mahwah, NJ: Lawrence Erlbaum. 

11. 
Wong, P. T. P. (in press,b). Meaning-centered counselling. In P. T. P, Wong & P. Fry (Eds.), The human quest for meaning: A handbook of psychological research and clinical applications. Ill 

Mahwah, NJ: Lawrence Erlbaum. 

12. 
Wong, P. T. P., & Weiner, 8. (1981 ). When people ask why questions and the heuristics of attributional search. Journal of Personality and Social Psychology, 40, 650-663. 


94 
The International Forum for Logotherapy, 1997, 20, 95-103. 
REFLECTION, MEANINGS, AND DREAMS 
Jim Lantz 
In logotherapy and existential analysis, dream reflection is considered to be a process of dialogue between the client dreamer and the logotherapist offering help.1 •2 The logotherapist's function is not to tell the client what the dream means nor to formulate "for" the client the unconscious material embedded in the dream.2 The therapist's function in logotherapy dream reflection should be "Socratic" in that the logotherapist should use interest, curiosity, concern, and questions to help the client focus upon the hints and clues in the dream that might help the client become more aware of repressed meaning potentials, problem-solving difficulties, and strengths and/or forgotten meanings previously actualized and deposited in the past. 1•2•5 As in psychoanalytic psychotherapy and Adlerian psychotherapy, dream reflection is best done after the client and therapist have developed a good treatment alliance.5 Such a positive treatment relationship allows the therapist to help the client use dream reflection to "notice" meaning potentials in the future, "actualize" and make use of such meaning potentials in the here and now, and "re-collect" and honor meanings previously actualized and deposited in the past.3 •4 •5 The following clinical material and case vignettes are presented to give the reader a "taste" of how dream reflection can be used in logotherapy to facilitate the treatment process. 
Noticing in a Dream by Bill 
Bill presented the following dream in his ninth logotherapy treatment interview: 
I was working with a bunch of men in a coal mine. The men left me off at the ninth level and I went down a long tunnel to a 
95 
wall of coal. My job was to dig out the coal so I used my pick ax and started to dig the coal. After a few minutes of digging I heard a voice from behind the wall of coal. I got scared, and then I woke up. I've had this dream about four or five times, and I always wake up when I hear the voice. It's a very scary dream. 
The following treatment dialogue occurred after Bill presented the above dream. The dialogue was recorded on audio tape and has been modified somewhat for purposes of brevity and to protect Bill's identity and confidentiality. Bill has given permission to utilize the following dialogue in this article: 
Therapist(T): 
Client (C): 
(Tl: 
(C): 
(T): 
(T): (C): 
(T): 
(C): 
(T): 
(C): 
Who were the men who left you off on the ninth level? Did you know them? Did you recognize them? No, I didn't know them. Any feeling about who they might be? Well, they were from my hometown. It's a coal town, you know. I don't know...maybe my uncles. Yea, probably my uncles. That feels right. How about the ninth level? What's that about? Any ideas? (The therapist knows that Bill's father died when Bill was nine years old.) 
(Long silence) 
Any ideas at all? No ... No, not really. 
(Silence) 
0.K., so let's go back to the coal wall. What does being next to a coal wall mean? What could it mean? Who was the voice? Who comes into mind? It just now popped into my mind. It's probably my father. He died in a coal mine accident. He died when I was nine. In some ways I've been hoping to hear his voice ever since. So, any chance getting dropped off on level nine speaks to this? (Starting to cry) Hell, yes! That's it! Level nine and I lost him when I was nine...God, that's clear! 
(Long period where client cries) 
96 
(Tl:  So look... these men who dropped you off..  
. maybe your uncles. Like did any of your  
uncles take you up and give you time after  
your dad died? Any of them help you out?  
(C):  Hell, no! ... Hell, no! I was on my own...  
like they helped mom out with money and  
stuff until she could get a job and start  
working. But hell, no!... My mom started  
working and my uncles didn't spend time with  
me at all. Hell, no!  
(T):  So this does not sit well with you... they left  
you off at level nine. No father, and left off to  
"pick" for yourself. (Long silence)  
(C):  God, yes...shit. I bet it's my father behind  
the wall. I bet it's his voice.  
(Long silence)  
(T):  Maybe yes... maybe no. Who else could it  
be? Who else might it be?  
(C):  Hell, I don't know... nobody. It's got to be  
my father.  
(Tl:  Anyone else you know who has lost a father?  
Anyone else you think it might be?  
(Client starts to cry again)  
(C):  Shit! It's my kids behind the wall. You're right.  
It was a child's voice! God. . . I'm a  
workaholic and I don't spend time with my  
kids. Damn... I'm doing the same thing to  
them that happened to me. Shit!  
(Client cries)  
(T):  Pretty good dream... real good dream...  
tough talking dream.  
(C):  Yea... Hell of a dream. I'm becoming a dead  
man to my kids. I put them behind a wall. ..  
God, I've got to turn this around.  
(T):  So the meaning potential in the dream is not  
being a dead man--a dead father to your kids,  
and the thing you need to do is to... ?  
(C):  Spend time with them. . . stop being a  
workaholic! Start being a father!  
(T):  Start being a father. Maybe take the  
opportunity your father never got. Do what  
your dad didn't get to learn to do.  
97  

(C): (Crying) Yea! That's it. It's a good dream... a tough dream! Shit... shit! 
Noticing in a Dream by Beth 
Beth requested logotherapy because she felt depressed, experienced anxiety attacks, had been "sleeping with every guy in town," and wanted to stop drinking. Beth initially had great difficulty talking during logotherapy sessions, and so she and the therapist used art and art reflection to help her talk. Beth stopped drinking and "sleeping around" during the initial stage of logotherapy and reported that using painting and "doing art" provided great relief. Beth continued to use art and art reflection throughout treatment but would occasionally bring in a dream to her treatment sessions for discussion and reflection. Beth provided the following dream at about the sixth month of treatment: 
I was walking down a street in my hometown and I went by some of my parents' friends. They all hung their heads and wouldn't look at me except for Mr. Jacks. Old man Jacks was always nice to me. He was my dad's best friend and I liked him. Well. .. old man Jacks told me that they were going to dinner but I couldn't come with them cause I wasn't clean. He told me I had to get clean before I could go to the table. I felt sad but I didn't argue. 
After considerable talk and reflection about the dream, Beth decided that "old man Jacks" was not being mean but wanted her to go back to church and go to confession and then take communion. In that way Beth could "go to the table" at her hometown Catholic church. Beth felt the dream was telling her that she was not "clean" because she had had an abortion after she was raped in her second year of college. Beth believed that she was a "baby killer." She felt that "old man Jacks" wanted her to go back to church and that he was "on my side." Beth felt that since "old man Jacks" wanted her to go back to church, that probably means "it's time." After this dream, Beth was able to "notice" her religious values and meanings and to return to her home parish. She went to confession and then took communion for the first time since she had been raped. For Beth, the meaning potential to be "noticed" in her dream was to "go back to church" and receive "forgiveness" from her priest, God, her parents, Ill community, and herself. 
98 
Noticing in a Dream by Sam 
Sam requested logotherapy because he was feeling "depressed" and was experiencing "confusion about my life." Sam was a 55-year-old widower who was proud to have raised "two wonderful children" who had both graduated from college. Sam worked as a comptroller in a company he had started, developed, and eventually sold when he was 50 years old. He was financially independent and could retire at "anytime". Sam reported that he was "tired of work," had been thinking of retirement, but didn't know "what to do" if he did retire. Sam reported the following dream in his fourteenth treatment interview: 
I was walking to work and I needed to get there by nine. When I came to Main Street, I turned left instead of going straight. I get to my office by going straight! I couldn't figure out why I turned left. The only thing that was on the left was my church, but it wasn't Sunday. There was no good reason for turning left. When I woke up I felt happy. 
Sam and the logotherapist spent a great deal of time reflecting on this dream. Both believed that "turning left" in the dream was important, and the logotherapist told Sam that he needed to "find out what's in that direction." After noticing that turning left would take him to his church, Sam reported that when he had been a young man, he wanted to go to a seminary and become a minister. Sam reported that he had given that up after he married and had kids. Sam decided that "going left on Main Street" was telling him that he should return to his old goal of enrolling in seminary school now that he had the "time and money." Sam did retire, and eventually he went to study theology at a seminary school. He got to study the material he didn't get to study when he was a young man. To Sam, the meaning potential discovered in his dream was "turning left" and returning to school "after all those years." Sam reported that his depression "evaporated" after his "Main Street" dream. Sam has moved out of the city to a small, rural town and is now a Deacon at a small, rural Episcopal church. 
Re-Collecting in a Dream by Eleanor 
The previous dreams and clinical material illustrate the use at the dream to help clients "notice" meaning potentials in their lives. The following material illustrates the logotherapy use of dream reflection to help the client remember, "re-collect," and honor meanings actualized previously and deposited in the past. 
99 
Eleanor was referred for logotherapy by one of the nurses at Eleanor's nursing home after the nurse had attended a workshop I presented on "logotherapy as reminiscence therapy." The nurse believed that Eleanor could use some help. Eleanor agreed that she felt bad and would be happy to have someone to "talk with." 
Eleanor initially responded extremely well to logotherapy (most likely because she was receiving special attention from another human being on a weekly basis). Her symptoms of depression rapidly lifted reactive to the attention she was receiving. After a few months of treatment, Eleanor started using logotherapy to remember, re-collect, and honor the meanings she had previously actualized and deposited "forever" in the past. During her ninth treatment session, she presented the following dream: 
was in a canoe with Betty, and we were floating down Sundy Creek. It was summer. Betty was my best friend when I was young. We went to grade school and high school together. We both loved to swim and hike and to float down the creek in that old canoe we had. We were laughing and probably talking about boys. That's the dream. Just me and Betty floating down Sundy Creek. 
The following dialogue is presented from memory (i.e., it was not tape recorded). As a result, it is probably not perfectly accurate, but both Eleanor and I believe it is '"essentially true" and catches the major points. This dialogue is somewhat changed to protect Eleanor's identity and confidentiality. 
Therapist(T):  Sundy  Creek.  So  you  grew  up  in  Athens  
County. Is that right?  
Client  (C):  How did you know that?  
(T):  My family is from Jacksonville and I know the  
area. So were you from Glouster, or Chauncy,  
or Jacksonville? Which one?  
(Cl:  (Laughing) None of them. I was from Shawnee  
and  we  would  go  to  Glouster and  put  the  
canoe  in  there  and  my father  would  drive  
downstream to Chauncy and pick us up there  
later in the day. It was nice.  
(T):  I know Shawnee. My great uncle  was  from  
there... his name was John Lantz... did you  
know him?  

100 
{C): 0 my goodness... you are one of them Shawnee Lantz's. (Laughing) You always seemed so nice. You can't be related to them. 
(Laughmg) 
(T): I'm afraid so. My family moved away... to get away from coal mining and lots of them moved to Columbus. Even some of the ones 
from Shawnee.  
(C):  My  goodness.  .  .  you  know  about  my  
hometown.  
(T):  So when did you move to Columbus?  

(C): When I got married. We moved so we could go to college. And then we had kids. But I still loved my hometown! 
!Tl: Do you ever go back? (C): Not for years and years. {T): What happened to Betty? {C): {Starting to cry) She died about ten years ago. 
She lived here at this nursing home for a while. i still miss her. 
(T): So tell me more about you and Betty and Shawnee and growing up in Southeast Ohio. Go ahead ... i really would like to hear. 
At this point Eleanor initiated the process of "re-collection." Over the next few months, she told me many wonderful stories about growing up in Southeast Ohio, about moving to Columbus, about raising her kids, and about work and friends. Eleanor enjoyed "re-collection" but felt "guilty" about "ruminating" on the past. She had apparently been told by some of the nurses at her nursing home that "ruminating on the past" was "bad." The following dialogue re-creates how the logotherapist helped Eleanor to understand that reminiscence and re-collection is not "bad." The therapist· s comments are based upon Frankl' s belief that remembering, recollecting, and honoring meanings previously actualized and deposited in the past is a useful and healthy way to shrink an existential vacuum in the "here and now."2 
Client (C): This was a wonderful session. I enjoyed talking about these things ever so much... even though it's bad. 
Therapist(T): Bad?... Bad?... How so? 
101 
(C):  Well, the nurses tell me I shouldn't spend so  
much time in the past. That it's bad for me.  
(T):  Really? I don't agree with that! I think they're  
wrong. I really do!  
(C):  Why?... please tell me!  
(T):  The things you told me about today are real.  
You did them. You and Betty and your father  
and your family, you did them. And you put  
these things into the past. You made them  
forever real. It's like you put them in a bank.  
They are yours, and you have every right to  
take them out and remember them and look at  
them and enjoy them again. That's your right,  
you did these things!. .. You made them real,  
and when you remember them, it's like you  
are "honoring" them. I really don't think that  
the nurses understand this... I think it's good  
for you to remember and be proud of the  
memories you made. I like the canoe memory  
best. . . just floating down Sundy Creek.  
That's a good one... I want to hear more!  
(C):  (Crying) Oh... that makes so much sense.  
Thank you... thank you so much.  

Actualizing in a Dream by Joyce 
All of the previous material has illustrated dream reflection used to "notice" meaning potentials in the future and to remember, "re-collect," and honor meanings previously actualized and deposited in the past. In the following clinical material the logotherapist and client used dream reflection to facilitate understanding and awareness of patterns that had disrupted the client's ability to "actualize" and make use of the meaning potentials m her life. In her sixth logotherapy treatment session, Joyce shared the following dream: 
I was in a taxicab. I was going to a job interview. When we got to the office building where I was to be interviewed, I tried to open the taxicab door, but it would not open. I asked the man who was driving the taxi to help, but he told me that he wouldn't help. So... I didn't get the job. 
102 
After considerable reflection about this dream, Joyce decided that the dream "outlined" her long-term pattern of trying to get other people to "do things for me." Joyce reported that she was "especially good" at getting men to "take care of me" and that she was disappointed because the logotherapist was not overly eager to "solve all my problems." Joyce decided that her dream gave her "permission" to tell the logotherapist about her "methods of getting by" that she "might use in therapy." Joyce and the logotherapist were able to use this dream to reflect upon their relationship, Joyce's consistent and repetitive "dependency" patterns, and to develop a treatment contract about what was "Joyce's job" and what was the "therapist's job." The dream helped to point out the dependency patterns Joyce used to disrupt her ability to actualize the "meaning potentials" in her life. 
Conclusion 
Dream reflection can be an effective element of the treatment process during logotherapy and existential analysis. It can be used by the logotherapist and client to help the client notice meaning potentials in the future, to re-collect and honor meanings previously actualized and deposited in the past, and to better understand functioning patterns used by the client to actualize or disrupt the meaning potentials in his/her life. 
JIM LANTZ, PH.D. (1947 College Road, Columbus, Ohio 43210 USA] is a Dip/ornate in logotherapy, Co-Director of Lantz and Lantz Counseling Associates, and a faculty member at The Ohio State University, College of Social Work. 
References 
1. Fabry, J. (1989). Logotherapeutic dream analysis: The royal road to the spiritual unconscious. In W. Fink, M. Fink, & L. Larson (Eds.). 
Pursuit of meaning: The road to self-esteem and social conscience 
(pp. 70-78). Berkeley: Institute of Logotherapy Press. 
2. 
Frankl, V. (1975). The unconscious God. NY: Simon & Schuster. 

3. 
Lantz, J. (1989). Meaning in profanity and pain. Voices, 25, 34-37. 

4. 
Lantz, J. (1993). Existential reflection and the unconscious ought. Voices, 29, 50-55. 

5. 
Lantz, J. (1996). What works in logotherapy? Voices, 32, 32-39. 


103 

The International Forum for Logotherapy, 199 7, 20, 104-112. 
LOGOTHERAPEUTIC TRANSCENDENTAL CRISIS INTERVENTION 
Jerry L. Long, Jr. 
The model proposed in this article has emerged from my experience with clients who have gone through a sudden crisis and attempted or contemplated suicide. Typical crises have included: unexpected breakup of a relationship, lay-off from "secure" employment, or adamant refusal of a partner to have children. The common denominators of these cases have been: first, they had experienced a severe loss which they could not handle successfully; second, they had not truly begun the grieving process so essential for recovery; third, 
5 68
they had experienced an existential vacuum;4· · · and fourth, they had developed what I call "emotional and spiritual myopia" (a severely restricted vision where they could see only one final and negative outcome--suicide). By "listening to my clients and learning from them, "4·5·8 I have developed a model of expanded crisis intervention that includes therapy after the crisis has been managed successfully. 
Seven Stages 
The theoretical foundation for my model has seven stages (see Figure). Many clinicians consider a crisis intervention successful if the client is able to return to the prior level of functioning. In contrast, logotherapy empowers the client to attain a higher level of functioning 
8 9 12
than before the trauma occurred.5· · · By skillful use of logotherapeutic techniques (Socratic dialogue, paradoxical intention, dereflection, and Ill modification of attitudes) the clinician seizes the opportunity to guide the client toward a stronger, more resilient, and spiritually based level of being.5·8· 11 
104 
Logotherapeutic Transcendental 
Stage 7 Crisis Intervention "Transcending the Trauma" 
Stage 1 Stage 6 ~ 
Current Level of Return lo Previous Functioning Level of Functioning 
Stage 2 
Baseline Level of
Onset of Crisis / Functioning 
r=---------'---------
Stage 3 Stage 5 
Rapid Descent Progressive Improvement into Despair during Clinical Intervention 
a-/ ~ 
0, 
Stage 4 
"Bottoming Out" 
Stage one is the client's current level of functioning. The irregular line illustrates the "ups" and "downs" of normal lite, which, of course, are different for each person. The irregularity of the line also symbolizes the fact that most people leave untapped their meanings of the moment and meanings universal (i.e., values). 
Stage two is the onset of crisis and its immediate consequences as the despair begins its destructive force. The person begins a rapid descent--and in some cases a plummeting--ot physiological, psychological, and spiritual energy. The person is not exercising their "defiant power of the human spirit." Typical symptoms include nihilistic thinking, increasing emotional or proximal isolation from others, sleep disturbance, deterioration of personal hygiene, change in eating habits, and substance abuse to "numb" the pain. A powerful sense of worthlessness and suicidal ideation often begins or is exacerbated. A vicious cycle emerges--hopelessness leads to fear, which increases the hopelessness, which becomes clinical depression. 
At stage three the downward spiral continues. The suicidal ideation often is transformed into establishing a plan of action. While the best time for professional intervention is immediately after the crisis, intervention at stage three still can overcome the client's "myopia" which sees suicide as the only way out. 
While most intervention models are successful, they do not go far enough. Logotherapy (unlike reductionistic intervention models) targets empowerment of the client's noos to increase self-esteem, develop effective coping mechanisms, and increase awareness of life-meanings. This reduces or wards off the destructive force of the crisis and improves the client's prognosis in subsequent therapy. Logotherapy, at this stage, enables the client to still have enough physiological, psychological, and noetic energy to actualize clinical intervention. 
At stage four--the "bottoming out"--the client is virtually powerless to activate any productive choices for meaning. The client still has the capacity to choose, but has lost touch with the "defiant power of the human spirit." The client usually does not see any option other than suicide. If the client does not get professional help at this stage, a threshold is reached where clinging to life becomes tenuous. The client feels as if in "emotional quicksand" or a bottomless pit.5·8· 10 There is no guarantee that logotherapeutic transcendental crisis intervention will be Ii successful, but at least the prognosis is far better than otherwise. The immediate task before the therapist is to empower the client, in some way, to say "yes" to life. To quote Richard Bach: "Here is a test to discover if your mission on Earth is finished. If you're alive, it isn't. "1 
106 
Many clinicians believe that intervention is successful if the crisis is resolved. But logotherapy's goal is twofold: to engender hope, and to help the client to say ~yes" to life.3•5 ·8 · 10 Once these two goals are met, therapy may proceed, moving onward toward ever-increasing awareness of purpose in life. 
When the immediate crisis and suicide have been averted, stage five--the middle phase of the counseling--has been reached. This is characterized by the "non-specifics" of psychotherapy: establishing rapport, building a bond of trust, demonstrating the client's belief that the therapist is competent, developing a therapeutic climate of honesty, safety, and comfort, building a treatment plan, helping the client implement "guiding suggestions," plus openness and flexibility of both client and therapist to modify the treatment plan if necessary. 3 
The logotherapist then helps the client explore and discover their unique meanings in life. This forms the cornerstone of healing during the therapy and beyond. The therapist empowers the client to utilize the "defiant power of the human spirit, ·7•8· 10 using this as a springboard for
"5 tapping the noetic resources and moving toward self-transcendence. At that point, I cannot emphasize enough the importance of steadfast incorporation of spirituality into the therapeutic process. As Frankl stated: "Unless we treat our patients as three-dimensional beings having not only somatic and psychic dimensions, but a spiritual dimension as well, then the only thing separating us from veterinarians is the chentele "5 Stage six, then, represents returning to the previous level of functioning. A great amount of improvement has occurred, but if we stop here we have done a disservice to our client. Just as the benchmark of Frankl's logotherapy is self-transcendence, the benchmark of logotherapy practice is transcendent therapy!5·8· 10·12 This term implies carrying intervention beyond a return to the client's previous level of functioning. it empowers the client to attain "loftier" goals such as: understanding more deeply what led to the emotional deterioration; developing better coping strategies to maximize independence for the inevitable future life stressors; building a more stable foundation for an increasingly secure, enriched quality of life; developing a better understanding of the "warning signs" that a crisis may occur if no preventive measures are taken; and becoming aware of and utilizing the "defiant power of the human spirit." The patient then moves to stage seven: the stage of "transcending the trauma." Here the client rises above the previous level of functioning to attain a higher and more noetically based life. Meaning, according to 
107 
Frankl, is a lifelong process, not a targeted goal. Therapy becomes increasingly focused toward drawing upon and helping to build up the patient's spiritual dimension. The "defiant power of the human spirit" is brought to the forefront. The client becomes increasingly independent and resourceful. This results in better managing daily life and living a more self-transcendent lifestyle. Their quality of life is enhanced, relationships improve, attitudes change for the better, behavior exudes optimism, energy level skyrockets, and giving of self to others and to causes is manifest. The client may truly achieve essence as a human being. At this Juncture, counseling sessions my be spaced farther apart, moving toward closure. 
Use of Techniques 
At stage one, no logotherapeutic technique is introduced because no professional intervention has begun. Some people intuitively draw upon their "defiant power of the human spirit" and cope with their various life crises. Such people also have the resiliency to "bounce back" before the potentially destructive effects occur when they are overwhelmed by sudden crises. 
logotherapeutic transcendental crisis intervention is indicated for a person who lacks the ability to actualize such potentials intuitively--such a person succumbs to the devastating effects of a serious crisis on physiological, psychological, and spiritual health. Such a person does not see much meaning in life, lacks purposeful direction, and experiences an existential vacuum. 
During stage two, the client becomes immersed in a sea of hopelessness and suffers from "emotional and spiritual myopia." The client may combine all the problems of normal life with the crisis (thus exacerbating the negative impact); may isolate from others; develop nihilistic thinking (which virtually eliminates any possibility of successful independent resolution); display "restricted vision" (which leads to greater despair); become the victim of substance abuse; and have 
10 12
thoughts of suicide.3· · 
108 
At this point, logotherapeutic transcendental crisis intervention focuses literally on saving the client's life. An effective strategy at this stage is the intertwining of the Socratic method and modification of attitudes. By carefully listening to and hearing the description of the client's plight, Socratic questioning elicits uniquely personal lifemeanings (e.g., a needy child, a caring spouse, a dependent family member, a project or dear piece of work left unfinished, a personal goal yet to be attained, etc.). 
Socratic dialogue is useful at this point for several reasons. It is not threatening and often results in garnering information useful in the course of the therapy. Second, it engenders some sense of hope. It must be remembered that the initial task is not to suddenly "solve" the client's problems, but to help the client climb out of the abyss of despair and see at least part of life as meaningful and positive, so the client no longer considers suicide as the only option. Third, the dialogue guides the client toward saying "yes" to life. Fourth, at this point modification of attitudes is woven into the therapeutic tapestry. By linking these two interventions together, the logotherapist not only elicits life-meanings but also helps the client tap into the previously dormant noetic dimension. thereby activating the "defiant power of the human spirit. "4 -5.1.s.s. ,o And fifth, these two logotherapeutic techniques help strengthen the client's tenuous hold on life in a non-directive, gentle manner. Thus, the client's sense of regaining some control over life bolsters a more solid feeling of identity and purpose. The two other logotherapeutic techniques, dereflection and paradoxical intention, being more direct and problem-solving, may overwhelm the client during this emotionally fragile state. 
During stage three, the Socratic dialogue and modification of attitudes remain the crucial therapeutic interventions. They serve in the aforementioned capacities but also slow down the patient's emotional deterioration. At this point, dereflection often proves effective in soothing the client's immediate pain and offering other, more positive, options than suicide.5·8 ·10 By focusing away from the narrow blinders of the immediate plight, the client is afforded an opportunity to focus instead (although temporarily at this point) on more optimistic matters. The client is beginning the process of self-transcendence even without knowing it. In an apparent paradox, the client is benefitting from therapy while, nonetheless, still spiraling downward. The intervention has a positive impact by stabilizing or "anchoring" the client while the full force of the crisis envelopes the client. This counteracts the 
109 
hopelessness that probably would occur in the absence of any intervention. 
Stage four occurs when the client truly experiences the emotionally devastating effects of the crisis. The client has attained insight into the ramifications of the crisis, often has experienced an overpowering sense of doom, and usually has developed a thorough knowledge of the "inner problems" that seem insurmountable. Stage four and the onset of the crisis are the times when the possibility of suicide is greatest. As with stages one through three, the preferred techniques in stage four are the Socratic method and modification of attitudes. The reason for this is that by being nondirective and non-threatening, these techniques do not shake the client's fragile emotional state. 
Stage five offers the opportunity of actively working in psychotherapy toward ever-increasing levels of good mental health. The Socratic method, modification of attitudes, and dereflection are the most beneficial techniques. After the "bottoming out" of stage four is managed successfully, the logotherapist may utilize the client's insights by helping the client apply that knowledge to improve and enhance overall quality of life. Among the goals are: establishing a more firm sense of identity; developing a better ability to correctly prioritize life tasks; interacting with others through improved relationships; forming a stronger sense of purpose and direction; improving coping skills; experiencing a greater sense of meaning in life; and having an enlightened awareness of how to use the "defiant power of the human 
"5
spirit. · 7•8 
When appropriate, paradoxical intention is a powerful technique at this stage, because the client is stronger and the directive nature of this approach is no longer perceived as threatening. However, the treatment plan must always be modified to serve the client's best interests. By the end of stage five the client is more functional and filled with hope where previously there was only despair. The client is ready to move on to stage six--the stage of returning to the previous level of functioning. 
it is fair to assume that by then, most parts of the client's life are back in order, self-esteem is improved, and outlook on life is more positive than before. But we have not yet empowered the client to reach the level of self-transcendence--the goal of logotherapeutic intervention. Therefore, the counseling should continue, striving to assist the client II& to reach stage seven--the stage of "transcending the trauma." 
This stage is shown in the Figure as a steady rise to a noetic (spiritual) level of functioning. Up to now, the client was moving through life in a "normal" manner, but the logotherapeutic goal during stage 
110 
seven is to help the client attain a noetically based level of existence.5 ·8 ·9 · 10 All four logotherapeutic methods are helpful, and must be used according to the needs of the unique client. But, by far. the most powerful technique at stage seven is modification of attitudes. The reason for this is straight forward--modification of attitudes is a noetically-based intervention. 
When entering stage seven, it is often clinically prudent to space the counseling sessions farther and farther apart before ending them. By increasing the periods between sessions, transference issues can be addressed and remedied; the client has the opportunity to "field test" the effects of the counseling sessions; and the client can use this period to gain a heightened sense of self-control and independence. Thus, the probability of a relapse is greatly diminished.5·8·1° 
When finally discharged, the client is likely to have a stronger sense of identity, a high meaning orientation, a distinct sense of purpose and direction, enhanced coping skills, and most importantly, a selftranscendent level of being.5 ·8 · 10 By accepting the challenge to take therapy that extra transcendental step from stage six to stage seven, the logotherapist assists the client in reaching a level of being that was thought to be virtually unattainable only months before. At this point, the client has reached the ultimate goal of logotherapeutic intervention-achievement of self-transcendence and actualization of human 
59 2
essence. · · 1 
JERRY L. LONG, JR., Ph.D. At the age of 17 Jerry Long became paralyzed from the shoulders down. After reading Viktor E. Frank/'s Man's Search for Meaning, he wrote to Frankl, "I broke my neck, it didn't break me." In Frankl's words, "Jerry Long is a living testimony to logotherapy lived and the defiant power of the human spirit." Currently he is in private practice in the Dallas/Fort Worth metroplex. Also, he is a frequent presenter at World Congresses and elsewhere. 
111 
References 
1. 
Bach, R. (1977). Illusions: Adventures of a reluctant messiah. NY: Delacorte Press. 

2. 
Fabry, J. B. (1995). Perscription for survival. The International Forum for Logotherapy, 18, 7-12. 

3. 
Frank, J. (1979). Persuasion and healing. NY: Harper & Row. 

4. 
Frankl, V. E. (1959). Man's search for meaning. Boston: Beacon Press. 

5. 
Frankl, V. E. (1965). The doctor and the soul. NY: Alfred A. Knopf. 

6. 
Frankl, V. E. (1966). What is meant by meaning? Journal of Existentialism, 7(25), 21-28. 

7. 
Frankl, V. E. (1969). The will to meaning. NY: World Publishing. 

8. 
Frankl, V. E. (1985, May 24). The rehumanization of psychotherapy. Paper presented at the University of Texas Health Sciences Center, Houston, TX. 

9. 
Long, J. L. (1986). Reasons versus causes as explanations of human behavior. The International Forum for Logotherapy, 9, 9399. 

10. 
Long, J. L. (1988). How to spot students in trouble. Unpublished doctoral internship specialty paper, University of Houston. 

11. 
Long, J. L. (1995). The quest for meaning in the twenty-first century. The International Forum for Logotherapy, 18, 60-62. 

12. 
Yalom, I. D. {1980). Existential psychotherapy. NY: Basic Books. 


112 
The International Forum for Logo therapy, 199 7, 20, 113-119. 
A FOUR-STEP MODEL OF LOGOTHERAPY 
Maria Ungar 
During my residency training at the Pastoral Institute in Calgary, Canada. I worked with clients from various backgrounds presenting a rich multitude of clinical cases in a multicultural community. As a student of Franklian therapy, I came to appreciate the usefulness of logotherapy. This paper examines a conceptual model for this approach. 

Client Population 
During my work I came into contact with 85 individuals. My clients came from various age groups, socio-economic strata, and religious denominations. At intake, about 75 percent reported symptoms of depression and low self-esteem; about 25 percent reported frustration with decision making, marital conflicts, abuse, problems with anger management, and/or addiction. Approximately half of the depression cases were reportedly reactive in nature. Symptomatology in all cases was followed up by the diagnostic consideration of whether the reported condition reflected endogenic depression, exogenic depression, neurotic depression. noogenic depression, psychosomatic illness, physical disease, or a combination of these. Counseling proceeded within the framework of an eciectic model and in close collaboration with other health professionals. 
Establishing Criteria 
Some clients could identify a particular event, or a set of events, as the root of their symptoms. They sought counseling to be able to cope with these events more effectively. Logotherapeutic intervention with 
113 
these clients was geared toward crisis intervention and crisis prevention. 
Other clients reported general dissatisfaction with their lives as the root of their symptoms. Many of them saw their lives in terms of "negative fragments." They recalled a couple of incidents as examples of their lack of success, happiness, and meaning; and they generalized these incidents to their life as a whole. In some extreme cases tragic circumstances were reported to be rooted in the experience of earlier generations and were described as "fate," a "vicious cycle," or "predestination" to a tragic end. Therapy with these clients proceeded from the symptoms reported, backward. Logotherapy was used to reconstruct their broken image of themselves and the world. 
Exploring Existential Dynamics 
Existential dynamics in logotherapy sees human existence in terms of a relationship between a person's meaning-orientation and his/her existential fulfillment; or conversely, a relationship between obstacles to his/her meaning-orientation and existential frustration.6 Research indicates that realizing meaning increases one's existential fulfillment and contributes to growth and development; and vice versa, lack of meaning m life feeds into existential frustration and adversities in development.2.4 Most importantly, however, both theory and research uphold the Franklian notion that both freedom and responsibility--the potentials to realize meaning under all circumstances--lie within the individual; as the realization of meaning is inherent in human 
existence. 1.2,3,5 
Growth/ Development Meaning-orientation 
Existential Existential Frustration-----------+ Fulfillment 

Thwarted Development 
114 
Within this frame of reference, the client's symptoms can be traced to one or several decisions (or coping strategies or patterns) that have failed to produce a desired effect because either they were ineffective, or they were mistakenly used as shortcuts to happiness instead of the real goal--pursuit of meaning. The client's condition deteriorates and is characterized by feelings of emptiness, existential vacuum, growing frustration, regression, noogenic neurosis, or noogenic depression, and stagnation. 
Existential Treatment 
The diagram is a useful tool, guiding both clients and therapists in tracking and re-constructing every step, beginning from the symptoms reported. Lukas3 identifies four stages of guiding clients from victimization to empowerment. I adopted and elaborated these steps in delineating the following four stages of enhancing recovery through logotherapy: 
Step 1: Evaluating clients' life in terms of "gifts" received 
Clients' fragmented and often negative impressions of their own lives are used to reconstruct their "image" by taking each reported example as an illustration of meaning potentials. The clients are asked to recall incidents which they regarded as miracles that sustained them despite numerous tragic incidents in their lives. Examples include incidents of slips reported by an alcoholic, indicating the client's will to struggle to maintain sobriety despite temptation to resume full-blown drinking. Or. in the case of a couple, reports of meaningful encounters with each other. indicating love and care for each other. 
Step 2. Pinpointing hardships as opportunities to respond 
During this stage clients reflect on their tragic triad (unavoidable pain, guilt, and death). The therapy is guided by the consideration that the very acceptance of this triad adds to life's worthwhileness--only in the face of guilt does it make sense to improve, only in the face of unavoidable pain is it meaningful to change, only in the face of death is it meaningful to act. Clients identify one or two tragic events in the past, and we explore what has helped them survive. We recall miracles mentioned during the first stage in order to help them draw the conclusion that meaning is often hidden from our eyes, either because we do not see it at the time or because it exists in a dimension unattainable to us. However, if there is meaning. there is a call to respond to it, a call that, as their reports show, has been there all along. 
115 
Step 3. Highlighting clients' ability to respond to their inner call 
In the third stage the therapist allows the client's personality to unfold. In the process of recovery, clients will gradually sight a meaning horizon, filled with guideposts. These gradually merge with their values (attitudinal, creative, and experiential). This stage is one of heightened spiritual awareness during which clients have an opportunity to recover their relationship with their spiritual core, significant others, and the transcendent. The therapist's role is to stand back, encourage, and support. 
Step 4. Supporting decision making and commitment to action 
Clients have to undertake the final stage on their own. The decision to pursue meanings awaits them. The therapist cannot do it for them. The decision to act on one's inner call has to be a personal resolution and is most effective and long-lasting when clients undertake it on their own. Therapy enables clients to see their choices more clearly, and it supports them in their decision, but it should never take away the responsibility that goes with decision making. Without this reservation we would compromise the most important value in therapy: human dignity. 
A Case Example 
I provided the four-step, meaning-oriented therapy to one of my young clients who wished to cope more effectively with her past which was filled with memories of abuse: 
If you were to try to visualize all the negatives we have talked about earlier, they would probably fit into a triangle [drawing a triangle] built from pain, guilt, and death. This would represent the suffering you experienced: all the instances when terrible things happened to you; times when you wished things were different; times when you felt desperate and alone... However, we can build another triangle [drawing another triangle inverted to the first one] comprised of the things that you have said helped you survive through all these hard years: the things that you enjoyed doing (we called these your creative values); the good things you experienced (your experiential values), and all the other things that helped you stay healthy and survive (your heroic attitudes). So, if we were to summarize everything, we'd end up with a star [pointing to the drawing]. This star is YOU; as you have been, as you are now, and as you can be 
116 
[adding some twinkles and radiance to the star]. It is unique, as you yourself are unique because no one else in the world has experienced the same things as you have. And it is also unique because no one else in the world can create the same things with your star as you can. You can shine in front of other people in ways that only you alone are capable of--exactly because of the experiences you have had. By the end of therapy, then, this is what you will take with you--a STAR. And if you will, you will shine in front of others; you will radiate to them what you are, simply because of who you are. 
Her response stunned me with its magnificent simplicity and honesty: "All I ever heard in life from others is WHAT I CANNOT DO. You are the first one to talk to me about WHAT I CAN DO." Then, we proceeded with therapy in all seriousness and paid due concern to issues related to abuse and her responses to those issues. Franklian therapy helped my client appreciate her change in role from victim to Victor" 
Outcomes and Conclusions 
With 85 clients interviewed, noogenic factors were thought to be involved in over 80 percent of all cases (70 individuals). Forty-eight of these 70 clients were treated with logotherapy as the primary mode of therapy. Logotherapeutic considerations were helpfully injected in the treatment of the other 37 (of the 85) clients, when conditions called for logotherapeutic crisis intervention, group therapy, or other therapeutic interventions, respectively. 
Of the total 48 cases in which logotherapy was applied as the primary mode of therapy, 12 individuals reported "significant changes in life," 20 reported "improvement," 6 reported "minor improvement," 3 were transferred upon reporting "no improvement," and 7 dropped out of therapy. The average length of therapy was six sessions (excluding the initial interview and follow-ups). [Average duration of treatment at the Pastoral Institute, using mainly the cognitive-behavioral approach and solution-focused therapy, is five sessions.] 
On the basis of the above results, logotherapy as a primary mode of therapy was successfully applied in about 80 percent (38/48) of those cases which were noogenic in nature and deep seated in origin. The average length of therapy was similar to the duration of other therapies at the Institute. 
117 
Logotherapy appears to be a useful therapeutic tool in the treatment of noogenic disorders, but the current results also highlight the importance of therapist flexibility. Applying logotherapy within the framework of an eclectic model calls for paying special attention to clients' needs, understanding of themselves, commitment to therapy, and improvement. I found logotherapy to work best with highly motivated and psychologically minded individuals. It did not work as well with individuals who expected "advice" from the therapist. 
Concluding Comments 
I found the four-step model very helpful because it allowed uncovering the "roots" of my clients' reported symptoms, while simultaneously providing tools for building on the "rocks" found inside. The diagram helped us understand what we saw, while the four steps helped us correct what went wrong, and logophilosophy put our work into perspective. 
Let me illustrate what I learned from cases when I successfully applied the Franklian approach: My clients and I could have tried to ignore the rocks we found during therapy; and we would have stumbled on them. We could have tried to remove them; in vain. Instead, we used a "chisel" to carve the stone. We were hoping to reach the precious stone laying hidden deep inside, and, as we chiseled, the rocks began to dazzle as the stone was overpowered with light. Then, we saw the rocks emerging as facets of a brilliant diamond. 
MARIA UNGAR. MEd (12731 Bonaventure Dr., S.E., Calgary, Alberta, T2J 4 T9 Canada] is a former student ofDrs. Robert and Dorothy Barnes currently completing her Doctoral studies at the University of Alberta, Canada. 
Ill 
118 
References 
1. 
Barnes, R. C. (1995). Logotherapy and the human spmt. Unpublished manuscript, Hardin-Simmons University, Abilene, Texas. 

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

3. 
Frankl, V. E. (1967). Psychotherapy and existentialism. NY: Simon & Schuster. 

4. 
Guttman, D., & Cohen. B. Z. (1993). Excessive behaviors and meaning-in-life among the active elderly in Israel. Journal des Viktor-Frankl-lnstituts. An International Journal for Logotherapy and Existential Analysis, 1(2), 38-55. 

5. 
Lukas. E. (1994). Psychotherapie in Wiirde [Psychotherapy with dignity}. Berlin-Munchen: Ouintessenz. 

6. 
Muller, K. H. (1996). "Der verbaute Weg." 0berlegungen zu einer Existenzanalyse de Sucht. Logotherapie und Existenzanalyse [Logotherapy and Existential Analysis}, 3/4, 4373. 


119 
The International Forum for Logotherapy, 1997, 20, 120-122.  
MEANING IN GRIEF  
William M. Harris  
It was late in the afternoon when  
the phone call came. A woman had  
died on a unit where people are often  
kept comfortable for their last days.  
When I arrived, her two middle-aged  
sons were pacing the room. They  
seemed to be in a hurry to get the  
administrative matters over. They did  
not seem to want to linger or to talk  
about their mother.  
Still I felt a quiet undercurrent as  
they talked. It was like a grief  
beneath the grief of death. Some sort  
of unresolved pain which had been a  
haunting secret, an unresolved con 
flict. It seemed like they were sharing something too horrible to talk  
about that, ironically, was obviously the center of their communication.  
i waited with them for nearly a quarter of an hour, listening but not  
understanding what was happening. Finally I took a risk. "You seem to  
have some sort of special concerns about your mother. I don't quite  
understand what it is that you seem to be struggling with."  
They cast their eyes down and said nothing. Then they looked at  
each other and back at the floor. The younger one, I think his name was  
Bob, cleared his throat and haltingly said, "It's ah, well, ah difficult. You  
probably wouldn't understand."  
Silence.  
"That's possible. But if it would help, I'm willing to try," I said.  
Randy, the older brother, looked right at me. "You couldn't possibly  
understand. She was our mother. But it was like we never had a  
mother. Long ago the doctors said she had schizophrenia. We missed  ..a  
out on having a mother. If you haven't lived it, you couldn't  •  
understand."  
I nodded. "I know what you mean. I have a sister-in-law who suffers  
from schizophrenia. And my son suffers from a related disorder. I know  

120 
exactly what you mean. If you haven't lived with it, all the explanations in the world wouldn't do it justice." 
It was like a dam had broken. A torrent of words about their pain came out. Words of relief that she was finally dead. Now she as well as they could be at peace. I thought of childlike sibling rivalry as they competed to tell me of their suffering. They told me what is was like having a mother who could not be their mother. Bob remembered what it was like to want to cuddle up with mom when they were scared as children, but she was often unable to attend to him. He missed her when she had to go away for hospitalizations. Randy told me how they had tried to cope with the cruel comments of teenage peers. Together they spoke of the agony of blaming themselves for her condition. 
I asked them what they knew about schizophrenia as a medical condition. Had they ever talked with any of her doctors? No doctor had ever told them that it was not the boys fault their mother was sick. They had been told in detail about their mother's cancer which had killed her. But they had never been told what they could expect or how to help her when she was dismissed from the psychiatric hospital. The state hospital was eventually shut down, and they became her caregivers without clear ideas of how to give her care. 
I shared a little that I had learned about schizophrenia. I told them that in the last couple of decades the technology has developed to prove that this terrible disease is an organic brain dysfunction. i shared that research in this area is advancing at a furious pace, as fast or faster than any other area in medical research. Randy and Bob listened with eagerness, a growing expression of relief spreading across their faces. They began to talk about certain events in their life which suddenly now made sense. 
After a long time of listening, I told them that they had an opportunity to help others. They could support some of the current research in brain disorders by donating their mother's brain. I told them how the McLean Brain Bank at Harvard University was a project supported by the National Institutes of Mental Health. If Randy and Bob wanted me to, I could arrange for the Brain Bank to get their mother's brain to researchers who were making progress on schizophrenia and related disorders. They both lit up at the possibility. 
I called the nursing supervisor to get the paper work started. The autopsy permit and other paper work were signed. The supervisor later commented how much these men seemed to be at peace with their mother's death. She wondered how donating her brain could contribute to their peace. 
121 
It was dark when Randy and Bob left the building. Their mother's body was wheeled out of the room. But they were smiling. The burden they had carried for years no longer weighed them down. It was not a happy smile. They had the special smile of someone who is at peace. 
I got home late that night. I didn't mind. I was smiling also. 
Logotherapy teaches that human beings can bear an incredible amount of suffering when there is meaning found in that suffering. Randy and Bob had been taught to do the right thing. They had fulfilled their duty to their mother over the years, but it had always been a duty, a burden borne in the silence of quiet desperation. Since childhood they had suffered the illusion that they had done something to make their mother remote and unavailable. Yet still they had struggled, sometimes despite great personal difficulties, to be decent sons who treated their mother with dignity, care, and respect. 
When they learned their mother had suffered a biological brain disorder, it was like a great burden had been lifted. They had not caused her condition. A dozen illogical events in their lives now suddenly made sense when they understood that her brain was not processing thoughts normally. That realization brought them tremendous relief. They grieved but they were no longer in despair. 
Relief was good. It could bring the hope of peace and resolution. But relief did not bring smiles. Logotherapy offers a second insight into this situation. These two men could have easily turned inward in their grief. But they were offered the opportunity for self-transcendence. They could give help to a legion of unknown strangers who still suffer as they once did. It was when they looked beyond themselves that they could move from mere resolution to genuine happiness. 
Randy and Bob were still grieving for their mother's death. But the pain was bearable. Bob later sent me a note thanking me for helping him find a special kind of joy that he had never known before. I had done that, but in a sense it was not really me. Logotherapy training had helped me to challenge them to self-transcendence. And that is what brought them a profound happiness at the very time of their deepest grief. 
WILLIAM M. HARRIS, D.Min. [309 S. Main St., Willard, Missouri, 65781 USA] is Chaplain at the Cox Health Systems, Springfield, Missouri. 
122 
ISSN 0190-3379 IFODL 20(2)65-128(1997) 
The International Forum for 
LOGOTHERAPY 
Journal of Search for Meaning