diff --git "a/SOURCE_DOCUMENTS/journal_011_2.txt" "b/SOURCE_DOCUMENTS/journal_011_2.txt" new file mode 100644--- /dev/null +++ "b/SOURCE_DOCUMENTS/journal_011_2.txt" @@ -0,0 +1,792 @@ + +Volume II, Number 2 Fall/Winter 1988 +CONTENTS +Clinical Application of the Logochart. ................ . 67 Manoochehr Khatami +The PIL Test: Administration, Interpretation, Uses Theory and Critique................................ . James C. Crumbaugh and Rosemary Henrion + +A Review of the Purpose in Life Te::;t ............... • • • • 89 t.- +R. R. Hutzell +Group Therapy in Latin America ..................... . 102 Jose V. Martinez Romero +Logotherapy and the Hypersomatic Family ........ • • • • · 107 Jim Lantz and Karen V. Harper +Logotheory in Hospice Social Work . . . . . . . . . . . . . . . . . . . . 111 Ellen Gibson, Janet Forrest, Elisa McIntyre, Marilyn Shannon, Jean Stephan, and Pam Walker +Family Logotherapy for Weight Reduction ... 117 .Tim Lantz and Karen T. Harper +Comparison Socrates and Frankl ........................122 William Blair Gould +Book Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 + +INSTITUTE OF LOGOTHERAPY +P.O. BOX 156 • BERKELEY, CA 94704 (415) 845-2522 +World Congress VII: The Pursuit of Meaning -the Road to Self-Esteem: +An Invitation to Celebrate its Relevance to the Wisdom of Life +Vera Lieban-Kalmar +The First World Congress of Logothcrapy was held in San Diego, California, in l9X0. It was a historic event which put the Institute of Logothcrapy on the map of the psychology landscape as the first organization to provide a nonprofit educational forum to cultivate, promote, and communicate the uniqueness of logotherapy among psychological schools. +The First World Congress started a series of congresses. Each was to combine logotherapeutic concepts with current world issues. Thus, the theme of the Second World Congress, held 1982 in Hartford, Connecticut, was "Education for Responsibility." It explored the dual role of the logotherapeutic concept "freedom of will." In light of contemporary issues this concept meant freedom of choice but also education for responsible decision making. 1 +The theme of the Third World Congress (Regensburg, West Germany, 1983) was "Prescription for Survival." The issue focused on the areas of fate versus freedom individuals have at their disposal. It served to encourage. persons to leave their victimized, fatalistic, help-and hopeless positions behind and explore options available to them. 1 +The Fourth World Congress (San Francisco, California, 1984) offered the theme "Human Rights and Human Dignity." The emphasis was on the uniqueness of the individual as seen from logotheory coping with "the resolution of a fundamental tension in human interrelationships ... which touches the lives of each of us as both persons and profcssionals."6 This theme concerned itself with the functions of the noodynamic antagonism.2,p.58 +The title of the Fifth World Congress (Toronto, Canada, 1986) was "Personal Conscience and Global Concern." Emphasized was the applied part of logotherapy. Participants had a first-hand experience to observe "logotherapy in action" through contact sessions dealing with personal and global concerns. The Sixth World Congress (Buenos Aires, Argentina, 1987) had as its theme, "Dilemma of Contemporary Man," appropriate for the countries emerging into twentieth-century technology. +The Seventh World Congress (Kansas City, Missouri, June 22-25, 1989) bears similarities to the first. At the first, the 75th birthday of the founder of logotherapy, Dr. Viktor Frankl, was celebrated. This year's Congress celebrates the 80th birthday of the founder of the Institute of Logotherapy, Dr. Joseph Fabry. The Congress bears the title of his book, "The Pursuit of Meaning." To link this topic to current issues, "The Road to Self-Esteem and Social Responsibility" was added. +The importance of self-esteem was stressed in California when Assembly Bill AB-3659, introduced by Assemblyman John Vasconcellos, a friend and supporter of the Institute, created a task force to establish "legislative findings and declarations as to the causal relationships between a sense of low self-esteem and many of the state's social problems. "5 A "Task Force to Promote. Self-Esteem and Personal and Social Responsibility" was formed, to create public awareness, on the county and local level, of the link between positive self-esteem and personal and social responsibility. What receives insufficient focus, however, are the contributive factors forming positive self-esteem that would in turn create responsible behavior toward oneself and society .. This is where logotherapy can offer practical and theoretical insights which so far the Task Force is grappling with. +Positive self-esteem is part of living a meaning-oriented life. It develops through problem solving and decisions acted upon. In this regard Frankl quotes Hillel, the great Jewish sage who lived nearly two millennia ago: "If I don't do it -who will do it? And if I don't do it right now -when should I do it? But if I do it for my own sake -what am I?" 3,p55 According to Frankl, this saying refers to the uniqueness of the individual, the uniqueness of circumstances and time, and also to the self-transcending quality of human existence. Fully human beings never act for their own sake only = this is the essence of positive selfesteem.3,p55 This year's Congress covers both concepts -the pursuit of meaning and personal and social responsibility. +Come and join us to celebrate in true logotherapeutic fashion the affirmation of logotherapy with its friends, supporters, and protagonists. As participants in previous congresses know, world congresses stimulate the mind through information, and the soul through warm social contacts. +VERA LIEBAN KALMAR, Ed, D. is director of training and education of the Viktor Frankl Institute of Logotherapy, Berkeley, and pro).{mm director(>{ the Seventh World Congress of Logoz/JcrarJy. +REFERENCES +I. Frankl, V .E. "The C:isl: of Tragic Optimism," Plenary address at the Third World Congress, Regensburg, Germany, 1983. +2. . P.0Y~bt..llher;1py and Ex istcnti:il i,rn, New York, Washington +Squan: Press, 1985. _. Will to ~k,tnirig, New York, New American Library, 1969. +4. +Licban-Kalrnar, V. "Effects of Dccision-t\1uking on Locus uf Control; rrankl's Purpose in Life Jnd AL'adcrnic Behavior of High School StudcnL,." Unpubl. Dissert. Univ. uf San Francisco, 1982. + +5. +Vasconcdlus, J. AssL'.mbly Bill 3659, a[Jprnvcd by Governor Sept,. 23, 1986, Sacramento, California. + + +(1. Wawrytko, S. "Prugram or the Fourth \Vorld Congress or Logothcrapy," San Franciasco, 1984. +MEMO +From: The Board of Directors of The Vik tor Frankl Institute of +Logotherapy To: Our members and subscribers Re: Name change +The Board of Directors of the Institute decided at its meeting of March 12, 1989 to change the name of the Institute, Following the trend established in many countries the new name chosen by the Board was: +THE VIKTOR FRANKL INSTITUTE OF LOGOTHERAPY. +Please let us know if you agree with this change. +Meaningful Education +Elisabeth Lukas +What is the significance of education? Is education responsible if we fail or are successful in our development? Some psychologists assert this oversimplification. But education can be assigned only one-third of the success or failure. The other two-thirds come from our genetic make-up and our own contribution--how we manage what we have received through genes and education. +Although education accounts for only part of our development, the importance of a meaningful education cannot be denied. First, the influence of even only one-third is important and, secondly, we live in a time when educators feel greatly insecure. My suggestions here are to encourage educators to support well-developed young people in the development they have achieved, and to enable psychologically warped young people to reach their full potential. +Educational texts tell us that children need love. Parents need to bring up their children with love. True enough, but children also need the capacity to be loved. Hence, parents should educate their children not only with love butjor love. Here we proceed from the level of advising parents and teachers to help children and students meet their needs, to the next-higher level in which youngsters are equipped with qualities that will help them in situations where they are needed. +An example will illustrate the difference between the two levels. How, for instance, can brutality and excesses in soccer and other sports be prevented? How can spectators be protected from dangerous aggressive acts by juvenile fanatics? Many politicians and educators offer young rowdies alternatives to gratify their needs--fan clubs, youth rallies, workshops, and their own small sport arenas in which they can "meaningfully" abreact their excess energies. What is overlooked is that meaningful abreacting is not possible. All abreacting is a discharge into "anywhere." But "anywhere" is no meaningful goal even if its target is a harmless surrogate. For example, if people quarrel with a friend, and then hurry home and slam the door rather than kick a dog, they have chosen a hannless target because the door does not feel the pain the dog would feel. But slamming doors is not a meaningful goal. +The model project has another flaw. Its only concern is gratifying an urge. Whatever our young need, the educators say, let them have it. And if they still don't develop desirably and need something else--let them have that, too. By this method we never get beyond supplying their wants and needs but we don't educate them for being needed. This, however, would meet their most profound "need"--the wish to be useful to others and the world. +Educator Eduard Spanger once said that the most fundamental difference in our world views is between drifting and feeling responsible. What he meant, no doubt, was: It is not enough to show young people in which direction they might drift without doing harm; they have to accept responsibility and learn to pick up the reins themselves--even against the pressures of drives and needs. Responsibility means, for instance, after a quarrel with a friend to neither smash the door nor kick the dog (both of which have nothing to do with the quarrel) but to search for compromise and reconciliation. +Therefore meaningful education will teach children two central guidelines: (1) aggressive urges must not be directed against others, least of all against the innocent; (2) not everything that's easy is permitted. +I start with these guidelines because there are two psychological views which have confused educators and practically eliminated the two guidelines. +The Repression Theory +The first view is the repression theory (advanced by the followers of depth psychology); it says that all repressed aggression and frustration surface as neurosis or psychosomatic illness. This view leads to the conclusion that it is preferable to fight, curse, shout, and kick (regardless of the target), than to swallow anger because this will have pathologic consequences. Hence those soccer rowdies, who beat up people in the street if the "wrong" club has won, act psychohygienically correct: They don't swallow their anger. +Here is a case history of a patient that illustrates what happens when you follow the repression theory: +One of my patients was plagued by diarrhea. Her physician sent her to a psychotherapist who explored her childhood to find the trauma that would explain everything. Indeed, he discovered that she, as a 6-year-old, had lost her beloved father. She said she was so close to her father that at the moment of his death in the hospital she, at home, sensed the crisis and broke out in tears. The therapist, thereupon, revealed to her that she must have felt massive anger against her father because he had deserted her. The repressed anger had caused her illness. He prescribed scream therapy: she should put herself back into her childhood and express her anger in screaming, thus "dissolving" the trauma. Six months of screaming did not help, and she sought my advice. +My first aim was to prevent a new trauma, this time in the dimension of the spirit, and not in the psyche--a misinterpretation of humanness. True humanness selftranscends and is not satisfied with self-actualization (screamingly or not). It searches for self-transcending values it wishes to serve and not only for egocentric wishes on whose fulfillment it wants to be served. +I told the woman: "If as a child you really had such affection for your father, you felt at the moment of his death not that he wanted to desert you, but that fate tore him from you; that he could not be with you any longer; therefore there was no reason to be angry at him. If there was truly love between you and him, then you sensed that this love did not end with death--sensed this in the same way you sensed his death. Indeed this love lives on to this day. There is no reason to assume that your illness is caused by repressed anger." +She wiped off her tears and, relieved, confessed that all along she had felt her screaming was unjustified because, as I suspected, she still had loving memories of her father. +As for her intestinal troubles, it turned out that they were inherited, that as far back as her great grandmother family members had suffered from it. Her father's grandmother had suffered from acute cramps during her wedding, and was more absent than present, according to chuckling family lore. +This example reflects an anti-educational basic attitude, all too widespread today. If something isn't right with the children, the parents did something wrong, such as daring to die at the wrong time. We neglect to see that parents are not responsible for everything--our children are exposed to many influences. We cannot "shape" our children; they shape themselves. Parents and teachers only provide the tools for them to use their inner resources. +Hence talk about "accepting yourself as you are" is the same nonsense as the talk about "saying everything openly." None of us IS a certain way, we all live in the tension between the BE and the OUGHT, as Frankl expressed it. All of us can act differently at any time, we can become a bit more perfect if we want to, instead of BEING AS WE ARE. We cannot simply spill out anything that passes in our mind, or do anything without considering the effect on others; else we could condone any emotion-loaded knife battle; and words, too, can cut like knives. +So education must not get misled by the spectre of the repression theary--not every instance of self-control is repression. Only animals lack self-control and responsibility. Children are not animals, they have a conscience, can veto the unleashing of emotions and aggressions according to the motto: "Never mind the others, what counts is that I got rid of what hothered me." We don't get rid of the voice of conscience no matter how much anger we have screamed out of our system. A psychotherapy that creates a conflict with one's conscience is only a prescription for an existential crisis. +The "Easy Way" +The second important guideline for educators reminds us that: not everything that is easy is permitted. This guideline is denied not by the repression theory of depth psychology but by current family therapy. According to it, the victim is as guilty as the wrongdoer--indeed there are no victims, only carriers of symptoms. If a boy in school does not defend himself, it's his own fault when children attack him. If he grimaces in anguish, which makes the other children laugh, he actually has provoked his being tortured--it's that simple. The whole class is summarily tagged as being neurotic, and the helpless boy who does not know how to defend himself is considered the carrier of the neuroses in that class. Here again we see that oversimplified portrait of the human being: Those who are angry will hit or scream to get rid of the anger, and those who have an opportunity will attack because it's easy. The woman who walks by herself at night in the park should not be surprised to get raped. And parents who meet their children's every wish should not be surprised if the children exploit them. +Is this point of view morally defensible? Or is it not true that in every situation we are responsible for our action--attacks, rapes, exploitations--whether these are made easy or not? What is easy to do is not necessarily permitted, else one could strangle every baby in its crib because it's easy. +Here is an example from my practice. A wife who habitually humiliated her husband explained: "He accepts everything. If he would threaten to leave me I would respect him more; but I can do what I please with him and he will always be agreeable." I answered: "If he is always agreeable, then it's you who has to change. If you can do with him as you please, shouldn't you do what you ought to do? And the same goes for your relationship with all the people you meet. Shouldn't you demand of yourself the best possible conduct in your marriage rather than request from your husband a worse conduct, namely to threaten you? True, another husband may well have left you, but the fact that yours didn't may not be a sign of weakness but of love. Your conduct, however, doesn't show strength but lack of love." +"He should restrain me," she called out. "No," I replied, "the burden of restraint rests with you. If you work on yourself, you can grow into a loving woman, worthy of her man who, despite your provocations, remains kind to you." My words got to her because in her heart she knew full well that the abuse of her husband could not be shoved aside by saying "It's his own fault." +Children, too, test their limits and often know exactly what they can get away with when they visit Grandma but not with parents or teachers. They should not get stuck in this infantile state, which even a trained dog can attain. They should gradually reach a state in which they no longer ask what the rewards or punishments are, but what is right or wrong--a state in which not the reaction of others decides their actions but their own conscience. +Another example from my practice: I asked a couple of quarrelsome siblings to tell me two things they did not like to do. They said "doing homework" and "washing dishes." I asked them which they would choose if I requested them to do one of the two. "That's mean," they both said. "You see," I said, "if you make people choose between two negative alternatives, they are forced to do something they don't want, whichever way they choose. If you attack another child it has to choose between two negative alternatives: fight back though it doesn't really want to, or run away. It is either angry enough to respond to your aggression with aggressiveness or is "stupid" enough to capitulate. It wants to be neither aggressive nor stupid but you allowed no third alternative." +We discussed this a while and the children saw the possibility in future disagreements to give their friends "better alternatives." +Our education has to show that the guilty party is the aggressor or blackmailer, regardless of how the victim reacts; if the victim makes it easy for the wrongdoer, that's no excuse. +Denial of Life +In this discussion of "meaningful education" I have stressed a strengthening of the capacity to love and overcoming +aggressive potential and egoistic tendencies. We don't know what crises our t:hildren will face but we know they will face crises. Humankind now faces great dangers. Unconcern, egoistic self-interest, and indifference toward nature have produced massive pollution of the environment. The new disease AIDS can spread only because of lack of love--although tied to the love act---because a person who loves his partner will not expose him or her to a deadly infection merely for the sake of a few moments of lust. Here we are at a crossroad. Love-does it mean to love me or others? Being human--does it mean satisfying my own wishes all the way to "self-actualization" or does it mean orientation toward meaning and values all the way to "self-transcendence?" "Desirable self-image" is more than "identity." True, identity describes more than our unique qualities; it also includes our attitudes toward them. But our desirable self-image goes beyond that. It includes awareness of our humanness: whether we are driven, are responsible, make demands or fulfill tasks, seek pleasure or pursue meaning, see ourselves as victims of chance or as co-creators of an unfathomable but divine plan. +There is today a disease more infectious and deadly than AIDS: the disease of denial of life. It is characterized by a flight into the world of simulation. Denial of life seduces a person to drop into an unreal, dreamy, stupefied world which does not require problem-solving because problems are either not noted or seem to solve themselves. In the TV and video world one watches passively -slips into a dreamland, into the shoes of the hero who vanquishes every foe, into the bedroom of attractive and willing ladies; one enjoys the stories of fictitious creatures, and faces life and death far removed from our own. In the computer-game world one chases nonexistent foes, sinks ships of phantom enemies, plays tennis without rackets. In the rockmusic world one is submerged in deafening noise drowning out the real questions of life. Dancing to this music is no longer creative but an opportunity not to think, not to have to respond, <.;11bmasion into the din of nothingness. Stronger still is denial of life in the world of drugs: a sniff, an injection, and you float above reality into a fantasy world which pretends to be real . +In this kind of contentment--or, rather, this being content wirh simulation and nonreality--the self is only watching and passively experiencing, not acting and functioning. And when it comes to a confrontation with reality, requiring decision and acting, the emptiness of a meaningless existence is revealed. The unlived life exacts its tribute, often in the form of despair and suicide. If we wish to protect our young, our education will aim at strengthening their capacity to love, as well as their capacity to suffer. Persons able to suffer do not escape into a "painless" world of simulation when facing suffering; they confront it, possibly help ban it from the world, the real world. If this is not possible they accept it and courageously integrate it into their life, the real world. They do not need to deny life with its unavoidable suffering, if they are able to accept it. The capacity to tolerate suffering makes them unassailable and, at the same time, willing to act when necessary. +An educator will not purposely create suffering, of course, to strengthen the students' capacity to suffer. Neither true love nor fateful suffering can be artificially produced; they come as experience, our task is to respond to love and accept suffering. We face many chances to learn that there are different ways to respond to "fate." If a child loses a ball, we need not to promise a bigger and more beautiful ball to pacify the crying child, to "save the child a trauma." We can instead search with the child for new atitudes to the loss of the ball--a lesson that may well be a model for more serious deprivations. Such attitudes may take the form of "perhaps another child will find the ball and enjoy the find." Or, "Now I know what to buy for your birthday and you can help me pick out a new ball." +These minor educational opportunities also offer the chance to strengthen the ability to suffer if, for example, a family member suffers a serious misfortune. It might be a misfortune that can be overcome only by a joint effort requiring the rallying of all forces--uniting what was separated, comforting what was painful. +Education to a meaningful life requires education to courage and love. Only with courage can we educate children to courage--including courage to bear unavoidable blows of fate--and only with love can we educate to love--including love for life. +ELISABETH LUKAS.. Ph.D. is director of the Sou.th German Institute ofLogotherapy, Fiirstenfeldhruck near Munich, West Germany. +Logotherapy in Schools +Hans-Norbert Hoppe +According to a scientific study in West Gem1any, half of tht'. students have negative feelings toward school.4 +The fact is that the competitive spirit makes school a place of anxiety. A paralyzing fear of failure inhibits students to develop their abilities. A frightening number of students show symptoms of anxiety, aggressiveness, depression, lack of relationships and responsibleness, and a tendency toward i-;olation. At the same time they long for contacts, they feel Jriven, and are inclined toward consumerism and addiction. Insecurity often leads to confom1ity. +These symptoms may become pathogenic. +The causes lie in what Frankl calls "existential frustration" and "existential vacuum." Loss of traditional values leads to situations where people no longer know what they ought to do and eventually don't even know what they want to +do.2,p.13 Our society faces a ''crisis of commitment to values. "5,r-13 The young don't sense the orientation that can provide them with direction and security because the adults do not show them meaningful commitments. This is a tragic situation because the young, especially, need orientation, role models, and guidance in a value system, in order to transcend themselves. The problem is exacerbated because +• +Our society offers a vast variety of meaning potentials which makes choices difficult. + +• +Families, confused about educational goals, often are little more than communities of TV-watchers and consumers. + +• +Societal norms are oriented toward possessions and achievements. + + +Student distress forces teachers to realize that their vocational and educational training is insufficient. +Meaning-Oriented Education +A meaning-oriented education, using logotherapy, may provide more courage to a teaching profession suffering from administrative rigidity and the need to rehumanize education. +12 +The system must see the human being, as logotherapy does, as endowed with a spiritual dimension, free, responsible, selftranscendent, and self-distancing. +Here lies a promising field of creative research to translate the basic ideas of logotherapy into educational practice. Two ideas are important in working with young people: +I. The idea of the demand quality of life challenging teachers to remind students that they are "response-able" to these demands. This openness toward the world enables students to transcend themselves toward a meaning to be discovered, a person to love, a task to fulfill.3,P· 117ff This openness is futureoriented toward change, growth, possibilities. +2. The idea of individual uniqueness, a prerequisite for self-confidence and self-esteem. +To reach these goals we have to explore what teachers can do in the classrooms and what changes in administration are necessary. +The Role of the Teacher +Teachers, trained in logotherapy, can help students see the barriers to meaning in their lives, whether biological, psychological-social, or environmental. Teachers can help students realize that they have a "will to meaning," and that they have to go beyond the mere search in order to live and act meaningfully. +These changes do not require new teaching methods to be more effective, but a new teacher attitude: to view students along logotherapeutic lines and encourage them to develop their potentials. +In approaching these goals, teachers develop their own personalities. We need training seminars for teachers and meaning-oriented sharing groups. +Teaching is accomplished through Socratic dialogue, open in method, respecting the uniqueness of teacher and student. Teaching has to balance instruct.ion with studentstudent and student-teacher encounters. Overemphasis on instruction often prevents the human encounter. Encounter with students must be honest, open, respectful, and close. +This is the message students need to receive from teachers: +You are a worthwhile person, regardless of achievement, appearance, or behavior. You are important to me. I want to help you improve your understanding of math, spelling, and other subjects. I also want to help you -deal with aggression and overcome your anxieties. Your stuttering is not important. I want to hear what you wish to say. We will take our time, everybody is listening to you. +Teachers always ought to be aware of their role as models. Students watch to see whether their words match their actions. +By their attitude of caring, teachers -in my experience become partners to discuss with students their life aims and problems, even if this is not the teacher's intention. This attitude often results in person-to-person talks leading to logotherapeutic counseling which is necessary because at this stage of their development young people frequently suffer from existential vacuum. +Some subjects lend themselves easily to a discussion on meaning. Classes in literature may offer works about people in meaning crises and how they overcame them. Classes in philosophy may offer questions of meaning in philosophy and psychotherapy. Such topics often prompt students to further explore a life directed toward meaning. This work can continue beyond the classroom, in the homes of students or teachers. Some possibilities are: +•Reading +groups dealing with the topic of meaning. Reading material is selected that offers hope and presents the human being as self-transcendent and in search of meaning. + +•Open +discussion groups on questions of meaning. + +•Writing +groups that follow the insight that "to write is to read one's own self." Among suggested topics are fear, hope, courage, meaning, happiness. + + +In these times of increasing discouragement and lack of perspective, confrontation with literary texts encourages dialogue and liberates dormant meaning potentials. Thus: "If you see life as a task, you will always be able to bear it" (Marie Ebner-Eschenbach); "We cannot live without a lasting trust in something that is indestructible in ourselves" (Franz Kafka). +Students like such groups. They participate with intensity and are stimulated to meaningful actions and experiences. Sometimes I offer weekend meetings in which logotherapy is combined with the ideas of Ruth Cohn.1 +These extra-curricular efforts expand classroom possibilities. Teaching, beyond instruction, occurs on the basis of trust and genuine personal relationships, between teacher-students, and among students. +Changes in School Administration +Teachers have to consider how such work can be accomplished in addition to the regular teaching load and family obligations, especially when extra-curricular activities increase. Teachers will have to reduce their teaching load and spend time as logotherapists. +These activities will and should get the attention of the school administration. Teachers working toward these goals become advocates for the humanization of education. In talks with colleagues and the principal, and especially in conferences, they must draw attention to student distress and the necessity of trying new ways of teaching that promote teacher-student encounters, as well as encounters among teachers. Working circles are formed among kindred colleagues. Weekend seminars with colleagues can be arranged. In our school we have held two such seminars, one to discuss educational questions, the other dealing with depression among adolescents. My colleagues reacted skeptically but became interested when the social part of these meetings was not neglected. Needed are patience and perseverance. +Another field of logotherapeutic endeavor are lectures and seminars for parents. What is of utmost importance is supplementary work to overcome learning deficiencies. For instance, a group may practice effective learning strategies. Help may be offered to fit the needs of individuals in doing homework or preparing for tests. These efforts support students so they can handle their tasks with self-confidence. This can be accomplished by integrating work techniques with breathing exercises, autogenic training, paradoxical intention, and other methods. Such student assistance may lead to discussions of logotherapeutic ideas. Similarly, assistance in overcoming test phobia can be helpful. +Also useful are logotherapeutic confercnce hours with parents and students and a telephone call-in service, "students help students." This requires intensive training for participants. +Perhaps most importantly, we have to familiarize the general public with the ideas of logotherapy for alienated youth. +The core of such school programs is the inclusion of logotherapy in the training and continuing education of teachers. Logotherapists help clients discover meaning in their lives through human encounter and not through techniques The same is true for teachers. Logotherapeutically trained teachers will demand achievements and the meeting of schedules, but they +1 5 +will also encounter students on a human level so our schools are places of living and growing as well as of learning. +HANS-NORBERT HOPPE , M.A. in German literature and theology, is a high-school teacher in the Federal Republic of Germany, and now teaches at the German School in Washington, D.C. His article is an extension of two reports published in the Bulletin der Gesellschaft ftir Logotherapy und Existenzanalyse, Vienna, Austria. +REFERENCES: +I. Cohn, Ruth. "The Theme-Centered Interaction Method: Group Therapists as Group Educators." J. of Group Psychoanalysis and Process, 2(2), 1969. +2. +Frankl, Viktor E. Das Leiden am sinnloscn Leben. Frciburg, Herder, 1978. + +3. +_____. The Doctor and the Soul, New York, Vintage Books, 1986. + +4. +Haecker, H. and W. Werres. Schule und Untcrricht im Urteil dcr Schuler. Bern, P. Lang, 1983. + +5. +Kuenzlcin, G. "Die Jugendkrise ist die Krise der Erwachsenen," in Jugend der achtzigcr Jahrc. Arbeitstexte dcr Zcntralstelle fur Weltanschauungsfragen. Stuttgart, 24, 1983. + + +Logotherapeutic Approaches to Crisis Situations Uwe Boschemeyer +1. Intervention with Suicidals +In crisis intervention with suicidal persons I am guided by the logotherapeutic principle that they, too, are more than their problems. This concept allows me to differentiate between their feelings of despair and those feel in gs, however weak, still concerned with life. An appeal to these positive feelings may still be possible. This differentiation is helpful because it reduced the pressure flashing from the word "suicide." The following fifteen suggestions of Socratic dialogue show logotherapeutic aspects counselors may want to consider during the first encounter. +1. We sit here together, yet are worlds apart. I don't know what you are thinking and feeling. What I am thinking is this: I'd like to talk to you because I can see how low you feel. I wonder if we can find a bridge? +Right from the start I'd like to tell you that I have no strategy in building this bridge. When I say something you will always know what's on my mind. I'd be glad if we could find a way to one another, but I'll respect you if you don't want to. I have no control over your life. +2. +Life, your life, causes you pain -so much pain you don't want to live any longer, perhaps not even to talk any longer. We also can be silent together for a while. But if you wish to talk, tell me: what is your greatest difficulty, now, or has been for a long time? Would you care to tell me how this came about? (Wait for client to speak.) + +3. +I have heard what you said, and I have felt with you while you talked. It is not hard for me to understand why you feel you no longer want to live. + + +Don't worry that I want to persuade you to continue with your life. But I'd like to consider with you whether now is the time to part with your life. +4. +You have tried everything to solve your problems, or to find help in solving them. What have you done? Have you done everything to find a solution? + +5. +There has been much that was heavy, too heavy, to bear, and much was not your responsibility. I am thinking of ... (give examples from what client has said). Can you see that much of your pain was caused by others? (Name examples.) + +6. +Is there also some heavy load for which you are responsible yourself? I wouldn't be surprised. + + +Two kinds of lives +7. +You say you are tired of life. After what you told me I can guess where your difficulties lie. Now I ask myself: which life are you tired of -of the wide, all-encompassing life which includes laughter, love, and tears, or of your own life? What I mean is: is it possible that your despair concerns mostly your life and its lack of possibilities, or is it the wide, all-encompassing life that causes you despair? Or both? + +8. +You really don't want to stay alive? Is nothing left that attracts you, appeals to you? No longing, in a far-off corner of your soul, for the wide, all-encompassing life, with its love and laughter, the people, mountains, oceans? Nothing left within yourself on which you can build -perhaps for the first time? + +9. +One more thing: Could it not be that up to now you have overlooked something decisive? It's not we who ask questions of life, it's life that asks questions of us. If we have the belief that we can make our plans, ideas, and wishes come true, we'll be disappointed.But if we look for what life offers us, we open ourselves to the possibilities, and to the realities hidden within these possibilities. + +10. +What kind of questions might life ask of you? Perhaps this one: whether you want to give life another chance? Perhaps the only, the unique, value life offers you now is that you not throw it away, that you wait a little longer to see reasons to live. This may well be a significant question when we stand at a place where our flow of life has become nothing but a trickle, and we wait and hope that the water will begin to flow again. If we look for reasons to live, we'll probably find them. If we don't look -how can we find them? + +11. +You will say, all this sounds fine, but how do I handle my present problems? I don't know the answer right now, I have to think about it, perhaps ask colleagues and friends. It may be important to think about your heaviest burden right now, and which is the second heaviest, and what the other problems are like -what you can work on, beginning tomorrow, with my help if you wish. + + +But it could be that a problem cannot be solved -we'll see.Some distresses last, and yet there is no reason to end our life if we only can see something beyond the distress that makes life worth living. A simile comes to my mind: imagine a little foot-bridge across a creek.It has three planks and the middle one is broken. Certainly that makes crossing the bridge difficult. +Now suppose the middle plank cannot be replaced, and the other two, left and right, are renewed -the bridge would not be an architectural beauty but one could cross without trouble.You can look for new planks, and I'll look with you if you want me to. +Readiness to Walk on +12. But there is something I cannot do for you: make you want to walk a little farther in life, to keep on looking, to try once more to see if life is not still possible. +Do you really want to live no longer? Is there nothing within you that wants to live? No longing for something that might touch your heart? +I don't know why this comes to my mind right now but I remember an incident of my childhood. When I was a small boy, other boys pushed me into some water so I almost drowned. And at the moment when I was sure I would die I felt firm ground under my feet. Isn't it possible that our talk here could be a piece of firm ground for your life? +13. +I see you before me, in your sadness, I see that you are far removed from your true self, that you are in deep despair. And yet -or perhaps because of it -I ask you: are you personally at the end of your road, do you despair of yourself or do you think life itself is finished with you, has nothing more to offer to you? Can life itself be finished with you when it is so much larger, wider, deeper than you? And if you think that you personally are at the end of your road, how do you know that you are able to see the end of your road? Do you think you have explored all your possibilities, potentials, all your gifts? + +14. +You say again and again that you are tired of living. I believe you. I can see it in you. And yet I ask you because there still is time to ask: Don't you know, feel, sense that all we have is only one life, and that we have no second chance -neither you nor I? And: don't you want to see how your life will end when it is allowed to take its natural course? + +15. +If you leave now, I'll be thinking of you. I don't know if you will come back tomorrow, as I would suggest. I wish it for your sake as well as for mine. I wish it for my sake because I feel close to you, and I wish it for your sake because I deeply believe that every crisis, however long, offers a chance to finally reach what we have hoped for, perhaps even planned for. + + +I firmly believe that every one of us has a way out because we are surrounded by that large, wide, deep, allencompassing life that knows more than we can ever guess. +Let's begin tomorrow to look for concrete steps how you can get yourself out of this situation. +2. Work With the Grieving +In my work with the grieving, with people who think their lives have ended with the loss of someone they loved, I found helpful certain logotherapeutic approaches to a Socratic dialogue. The ten approaches listed may be useful also for those who have lost someone not through death but in other ways. +1. +To remain silent; to be present; to listen; to let you weep; to seek your eyes; to try to let our eyes build a bridge between us. To allow myself to be touched by your grief; to try to understand you in your world so different from mine. Do I sense how alienated you feel in your own life? Am I with you so you can find your way--even if only a little--to your old self? + +2. +Would you like to talk about your loss? Talk about what has alienated you from yourself and from life? + + +To talk means to liberate the spirit from the situation in which we find ourselves. Talk relates us to happiness and sadness, prevents thoughts and feelings from becoming traps. Talk brings order to thoughts and feelings, helps distancing from ourselves. +To talk things out is necessary in times of grief-especially in the beginning--when grieving persons no longer understand themselves because their feelings are chaotic: feelings of pain, despair, guilt, fear, anger, shame--feelings that lead to accusations and self-accusations; feelings of hopelessness. There are the "ifs" and "buts" thoughts--they have to be expressed. I have to listen, ask questions that show I understand; help you say what is difficult to say. Do I understand what is difficult for you to say? Talk liberates because confronting yourself is liberating. And that includes expressing what is difficult to express: that the other person is dead, really dead. +3. Three questions may help: +What is most difficult to bear? +To ask what is most difficult to bear also draws attention to what is less difficult, what may make life--perhaps only a little--more bearable. +ls there anything that surprises you? +To ask for surprises draws attention to the fact that life is ambivalent also in the most painful situations--that life can come forth when we least expect it. +What is your basic feeling now? +This question is not an encouragement to selfobservation, but an attempt to help grieving persons relate their +20 +feelings to their thinking and acting. This question may dig a first, perhaps narrow, passageway to the buried will to life--a meaningful life. +4. What did the dead person give you, what did you give him? What has she helped you become, what have you helped her become? How has he hurt you, how have you hurt him? +What was he to me? What were you to her? +Look at both sides--the difficult and the good. + +To look at the difficult is painful. There are things that cannot be changed. But you can mourn them, find relief in mourning. And you can feel remorse--about what you failed to do and to be. Remorse can liberate you from the weight in your soul, from the things where you hurt the deceased. Others still alive may profit by it--and so may you. +And the other, the good: How much of the good that you shared is still alive--actions, thoughts, feelings? What of the dead still lives in you, is not lost? Let's talk about this, too. +How much love did you give the deceased by the time he/she died? Yes, this was your achievement--you gave away the most precious gift in life--love. +You say, looking back, it has become clear to you that your love was not enough. Who can measure it? Wasn't it the love you could give? And if it wasn't enough wasn't it you who challenged the deceased to give his or her best? +Much remains unclear, in disarray, unfinished--this is the way things are, and not only for you. +Try to name things honestly, as well as you can. Perhaps this will free you to see the successful and meaningful that also happened. +5. Now the person is dead and you must live on. Do +you want to? Perhaps there is a No in you, perhaps also a Yes. That's the way it is in times of grief. I see something else which you may not see just now. +Life is more than partnership. Life contains more than love. It is useful to base our life on more than one area of meaning. +6. What else can you do? +My mind sees an image: I think of a river. On every bend the landscape changes, new towers, castles, villages, hills come into view. Traveling on a river always brings surprises. +Are there surprises, in life, also for you? Yes--new meaning offerings, new possibilities to live, and also to love. +That's what life is all about: constant change, always new meaning possibilities. We, too, change constantly, or can change because life offers us new meaning possibilities. +You can say Yes to this life that offers you new meaning possibilities, or you can say No to it. You have that freedom, the decision is yours. Are you aware of this? +Only you can decide whether you wish to go on living, and how you wish to go on. Only you. +If your answer is Yes, you will find reasons to live if you look for them. If your answer is No, you will find reasons not to continue living, if you look for them. +7. +Is there anything you want to continue because it was important to you and to the deceased in your life together? Is there anything you want to do now because you could not do it before? + +You may not know the answers to these questions right now. But you can and will find answers if you hold yourself open to the questions life asks you. But it also may be that you hear a new question even now, in our talk together. A question to which you know an answer. Only you will know. + +8. +You say love has left you. Does it mean you have no love left? I'm asking you: What is more difficult--no longer to be + +loved, or not be able to love? That's something we ought to talk about for a long time. + +9. +With every grieving comes the time when we have to let go our pain. But isn't it so that for many grieving persons the pain takes the place of the lost one? + +You ask yourself: is it right for me to let go of my pain? Don't I betray the dead if I let go of this feeling? Don't I lose the dead for good if I stop mourning? We must let go of the pain because it frees us to see new meaning possibilities. And we can let go if we open ourselves to the new questions , life asks of us. I wonder if you want to do that? + +10. +To endure the mourning is part of love. I ask you: what kind of love would that be which does not make you grow more mature and fit for living? And what kind of mourning would that be which does not sooner or later allow a smile at the thought of the person who still lives in you--as a gift to you? + + +That's another thing we could talk about for a long time. +UWE BOSCH EM EYER, Theo!. D. is director of the Institute for Integral Logotherapy in Hamburg, Germany. This article is translated, with permission,from Dr. Boschemeyer's book Mut zum Neubeginn (Courage for a New Beginning), published by Herder Taschenbuch Verlag, Freiburg, West Germany. +A Logotherapeutic Support Group for +Mothers of Special Children +Mary Harris Pegram +For the past year I have been the facilitator of a support group for mothers of special children at the Nisonger Center, Ohio State University. Nisonger is an evaluation, research, and treatment center that provides services for special children who must cope with mental retardation, physical handicaps, learning disabilities, or some form of developmental disability. Any child with a physical, neurological, or emotional problem that disrupts development or learning is an appropriate candidate for intervention at the Center. +The mothers' group was started as an educational and support group for mothers of special-needs children being treated and attending school at the Center. The group offers support, facilitates hope, provides information, suggests parenting strategies, and helps the mothers maintain self-esteem and morale in the face of the very difficult personal challenge of being a mother of a special-needs child. A special purpose of the group is to help the mothers discover, rediscover, or maintain a sense of meaning in the face of the problems associated with raising a special-needs child. +Members and Format +Seven mothers have been a part of the group and have consistently attended meetings. Two group members have a child who is severely physically handicapped. Three mothers have a child with Down's Syndrome, and two mothers have a child with Spina Bifita. One of the "Spina Bifita Mothers" has a second child who is hyperactive. Two mothers are black and five are white. All seven mothers are middle class and have "average" income. One of the mothers is divorced. Three of them have attended college and all seven have graduated from high school. +The group met once a week for an hour and a half. The group consistently met in the same room, and coffee, pop, and tea were provided. Each week, one or two mothers would volunteer to bring lunch for the group. All seven members were seen by the facilitator two or three times individually before they started in group, and were given pregroup information about the +23 +purpose of the group and their responsibilities as its members. +The role of the leader is to facilitate the work of the group. The facilitatot helps the group remember its purpose, focus, and tasks, and provides both support and confrontation, as needed. The facilitator gives advice, suggests problemsolving methods, and at times, "withdraws" from the group when the members start depending too much on him or her. The +facilitator uses the techniques developed by Frankl 1 and Lukas5 including existential reflection, Socratic questions and modification of attitudes to help group members reflect upon potential meanings to be discovered in their lives and to help them develop meaning awareness· 1,2,3,4,5 +Each week, group members were asked to suggest a topic for the next meeting. At times the facilitator suggested a topic and always gave reading suggestions for the topics. Sometimes we duplicated articles and passed them around for reading for the next meeting. After several months, the facilitator used self-awareness exercises in a guided group fantasy format to enhance existential reflection and Socratic questioning. One of the exercises required group members to visualize themselves and their special child in front of a full-length mirror, as they were at present. The facilitator then guided them to different times in the future. This exercise was preceded by relaxing exercises to help the group to become more amenable to fantasy. +The mirror exercise evoked very emotional responses from some of the group members. Reactions were discussed and the facilitator helped them to see how important it is for rhem to know their own feeling and to build lives for themselves that allow them to have some time and pleasure with their nonhandicapped children and their husbands. It also served to further their searches for meaning and they were able to articulate this in their own individual ways. +Five themes consistently emerge and re-emerge during group meetings. The mothers report that they feel all alone because "no one can take care of my child as well as I can." A second theme is that "My family doesn't understand." All seven mothers report that extended family members have a "superficial understanding of my child's problem and that makes me feel all alone." A third theme is that "people laugh and make fun of my child when I take him/her out in public." A fourth theme is guilt. All seven mothers wonder "What did I do to cause my child to have these problems?" The last theme which consistently emerges are the noetic questions of " What does it mean?" and "What's the meaning of my child's tragedy?" This is the theme which concerns the mothers the most. This noeticexistential theme, they report, is the least understood by most helping professionals. Most helping professionals "encourage us to keep quiet about it." +Reactions to the Group +All seven mothers report that the logotherapy-oriented group has been "very helpful" and that they wish to continue being a member of the group. They have learned new child management skills, feel "less guilty" and have become more comfortable "accepting help." All seven members report that the group has "helped us regain our self-esteem." They feel that the group "has helped us rediscover that having a special child gives us an opportunity to experience a very special kind of personal meaning." Other reactions to the group include: +(A) +Four out of seven group members report that they are not using "respite care" for their disabled child to give themselves an occasional rest from child-caring activities. The other three group members already did this. + +(B) +Five of the mothers were able to leave their child with a "trusted" person and had their first vacation "with just my husband" since the birth of their special child. + +(C) +Two members got pregnant and said "even if the new baby has problems it still is meaningful" to have another child. + +(D) +Four members report starting going "back to church." + +(E) +Six members report an improvement in their marriages. + +(F) +Three group members report that they feel better and no longer are taking "nerve medications." + +(G) +All seven members report that the group was the first" treatment experience" in which they were encouraged to reflect upon meaning and their opportunity to discover the "meanings embedded in their relationship with a special child." + + +The underlying working philosophy of the facilitator centered around attitude modification. In reaction "A," members of the group were probably just as influential as the facilitator. Some of them were already able to use respite care when they came to the group. The gave the other members encouragement and helpful practical information on making contact with the agency and on financial assistance for respite care. The facilitator continued to offer them support and another way of looking at themselves without the ever-present guilt. +In rection "B," mothers : were helped to see that they were not the only responsible people in their children's lives. They became able to allow other family members to help their children. Some of this was accomplished by having the group consider what would happen to their children, if they -the mothers -became disabled or died.We discussed legal guardians and gave them advice and literature on making wills and providing for their children in case of disaster. Once the mothers could see that there might, indeed, come a time when they could not care for their children, it became easier for them to relinquish that fonnidable responsibility now. +The group members who became pregnant were able to receive that news with hope rather than foreboding ("C"). The group had helped them reach a better understanding of themselves and their meaning. +It seems that parents of children with handicaps often experience an estrangement with the church and religion. The mothers in reaction "D" found a way back because of their better feeling about themselves and their search for meaning. +The improvement reported in the marriages in "E" seems to be a natural product of the other changes that were taking place in these women's lives. Their decisions to spend more time with their husbands and non-handicapped children made for more comfortable family life and marriage. A major factor in the improved attitudes was finding out that there were other women and other families in similar situations. Most of them had never had more than casual contact with such mothers before. In the group they found others who had this significant problem in common and who wanted to be helpful friends. In addition, they had a facilitator who was willing to be helpful. Even preparing the lunches was a boost to self-esteem, as we complimented each other. All of this led to improved marriages. +Much of the stress that accompanies the physical strain of having a "special" child is heightened by the guilt and emotional stress inherent in such a situation. Several mothers in reaction "F" were taking valium. Happily, they were able to find support and acceptance in the group, and this enabled them to discontinue the use of their "nerve" medicine. +All the mothers were included in reaction "G." It would seem that "A" through "F" led to this positive conclusion. Most other support groups in town are more like places where they can come to socialize and get information about schools and immunization, but there is very little for "them." It is gratifying to know that this group, by modifying attitudes, learning more +about themselves, and searching for the meaning of having a special child, has had some positive impact in their lives and allowed them to achieve the goals stated in their reactions. +MARY HARRIS PEGRAM, DSW, is an assistant professor at The Ohio State University College of Social Work and a social work consultant at social agencies in the midwest region. +REFERENCES +I. Frankl, V. The Will To Meaning, New York, New American Library, 1969. +2. +Lantz, J. "The Noetic Curative Factor in Group Therapy," The Intern. Forum for Logotherapy, 1..(21 1984. + +3. +__, and M. Pegram, "A Meaning Model in Family Treatment," The Intern. Forum for Logotherapy, llill.1988. + +4. +Lazar, E. "Logotherapeutic Support Groups for Cardiac Patients," The Intern. Forum for Logotherapy, 1..(21 1984. + +5. +Lukas, E. Meaning in Suffering. Berkeley, Inst. of Logotherapy Press, 1986. + + +MEMO +From: The Viktor Frankl Institute of Logotherapy To: Members and Subscribers Re: Life Memberships +We welcome our latest life members, Sister Kathleen Lynch, OLC, of Jamestown, North Dakota, who attended all six World Congresses of Logotherapy, Peter C. Moody, MD of Flint, Michigan, who joined the Institute only in 1987, and Judith Jones, Ph.D., of Fremont, California, who with her life-member husband, Frederick Jones, PhD have devoted years to the Institute and the promotion of logotherapy. They jointly edited the proceedings of the Fifth World Congress of Logotherapy, "Personal Conscience and Global Concern." The total number of life members of the Viktor Frankl Institute of Logotherapy, Berkeley, stands now at 32. +Logotherapy: Meaning and Intimacy +James D. Yoder +In reviewing my cases, I find that every counseling deals with closeness-intimacy on two levels: between counselor and client, and relating to the client's search for meaning. +Existential counseling is an "encounter," risking willingness to meet another person at a significant level, and focusing together on "meaning" beyond ourselves. Intimacy and closeness are experiential creating meanings. They may be at various depths, but we are changed and strengthened by them. +Logotherapists, open to their clients' ability to build relationships and experience intimacy, know that great spiritual energies, faith, hope and love are released. Thus, meaning is experienced by closeness and the overcoming of alienation. +Frankl2 recognized that contemporary alienation is caused largely by rapid changes within a highly industrialized, technological society. The familiar landmarks that once guided us are gone--commandments of religion, respect for social institutions, the extended family, the "ar-homeness" in village or community. Gone also are many former rituals that celebrated important life stages. Without any sense of absolute meaning, people ask themselves, "What is the source of authority for my life and decision making?" Pragmatism has ruled for decades-truth is "what works," and "the end justifies the means." +Logotherapy, however, rediscovered logos, a life of meaning and intimacy which requires self-transcendence, directed to something beyond ourselves: +Self-transcendence means reaching out not only for a meaning to fulfill but also for another human being ... to love. To be sure, love goes beyond encounter . . . Encounter makes us realize the humanness of the partner, whereas loving him shows us more--his essential uniqueness.2 +Frankl believes that loving relations have eternal possibilities, whereas experiencing "a thing in the world," a freshly baked cookie, or a horseback ride, is a meaning-of-themoment encounter, limited and finite, bringing meaning fulfillment through creative or experiential values. +Establishing meaning through intimacy encompass all five areas where meaning is found: self-discovery, choice, uniqueness, responsibility, and self-transcendence.1 +Meanings found in intimacy may be discovered through creative values (creating a new relationship or a new atmosphere of love), experiential values (experiencing the uniqueness of another) and attitudinal values (not being able to change another person but to forgive, or facing suffering we cannot change). +It is the task of the logotherapist to 1) help clients open themselves to new possibilities, when choice and action can bring something "into being" in their lives; 2) help clients become conscious of what they intuitively know), help them gain insights for action aided by their conscience that dialogues with a meaning (logos) outside of self, thus providing insights for the appropriate choice moving toward love and intimacy. +Obstacles to Intimacy as Meaning +Some obstacles to intimacy are caused by modern trends and thought patterns in Western civilization: +1. +Being ignorant of our phenomenological/existential nature. Logotherapy is aware of the powers enabling relationships toward intimacy coming from the noos. We are "free to relate." This is a spiritual "given." + +2. +Becoming psychologically ill (neurotic, depressed, phobic) because of unresolved psychological fixations. Persons hyperreflecting on a psychological problem find little energy to look to meaning horizons. + +3. +Becoming psychologically ill because of physical conditions--depressed because of a chemical imbalance, in despair because of physical pain. + +4. +Avoiding intimacy because of inner emptiness and existential vacuum, a major neurosis of our time. + +5. +Lacking intimacy because of an unhealthy belief system. "I am a victim of my condition." "No woman can be trusted," "There is nothing I can do," "The main purpose in life is fun." + +6. +Disregarding existential facts that are discovered phenomenologically. Such as: meaning can be found by actualizing opportunities for closeness and intimacy; our basic motivational force is a "will-to-meaning" which could be interpreted as "will-to-intimacy"; all situations provide opportunities for meaning (intimacy), even those of affliction and suffering. + +7. +Not understanding that urges, drives and feelings belong to the psyche, and consciousness what to do about them to the noos. This enables self-distancing. Logotherapists help clients "step away" from feelings toward the meanings behind them. A relationship of intimacy is transcendent --in essence, spiritual. + + +Moving toward Intimacy +A year ago, Seth, a young business executive, filed for divorce but could not follow through, even though he no longer embraces the role of "husband." Neither he nor his estranged wife want to have joint counseling. He denies his freedom, prefers to spend the counseling time searching for "causes" for his indecision rather than deal with its immediacy -guilt, anxiety, the obligation for encounter. The logotherapist will emphasize: +1. +Self-distancing from feelings to see their message. + +2. +Dealing with the client's denial of his freedom by challenging the irrational thought ''I'm not free." + +3. +Preventing iatrogenic neurosis by focusing on his personal history which reveals how he has used his freedom in the past. + +4. +Disclosing how roles are identified and lived out by the client as well as the purposes behind the roles. + +5. +Focusing on issues of trust --of self, others, in life, to respond to his best efforts. + +6. +Focusing on the pathological need to hold on to the unhealthy role of "juggler" (see later) which damages others and produces guilt and anxiety, helping dereflect from this unhealthy condition toward the positive. + + +Counselor: You say "I'm fine" and skip over your pain. Client: It feels uncomfortable when I focus on the pain of the relationship. I try to avoid discussion about the subject. Counselor: What are you avoiding? You sigh. One would +expect pain at a crumbling relationship, pain at the risk of +deciding in a new relationship. Client: I'm uncomfortable because of my inclination to stay in the middle, weave back and forth, and the feelings of guilt I put upon myself. That's what I'm trying to avoid. +The client runs away from the important messages, from the guilt of exercising his freedom responsibly. He speaks of dealing with his estranged wife Louise, and Donna, whom he wants to marry, as all being involved in a "game plan." He freely admits that all three suffer because of his indecisiveness. He is in pain because he has missed opportunities for meaning by not being present as a father for his 18-month-old adopted daughter. When he speaks of his relationship with Donna, he identifies areas of meaning, closeness, understanding, sharing, unlike relations with his estranged wife. He cannot bypass the pain if he intends to experience intimacy and responsibleness. +Client: I know I can blow the cloud away, but it's painful. Counselor: What are you learning as a result of this struggle? "I tell Jim Yoder I have this cloud of pain and guilt. I have +the freedom to blow it away, but it's going to hurt." +Client: Life is not easy, not without pain. I know I have within my power the ability to blow the cloud away. Because it will be painful, I hope that something will happen to take care of it. +Counselor: That someone else will make a decision to change things, or that chance will do it? Important are your goals and the obstacles you place in front of achieving them. +Client: I feel my life is at a standstill . I'm not moving forward. +Counselor: "I am the person who vacillates. This is the way I am in the world today." How comfortable are you with that? +Client: (Sigh). It's uncomfortable , yet it's comforting in the sense that I haven't experienced the pain that blowing away the cloud would produce. I'm in pain because I'm avoiding pain. +Counselor: That's a heavy kind of pain. An anticipatory pain-the idea that your decisions will produce pain. It becomes a debilitating circle. What needs to be done to break the cycle? +Client: (Reads what he wrote to help him focus upon his role and responsibilities as a husband. He sees himself as provider of physical support for his estranged wife, but little more. Commitment and emotional support are glaringly absent.) +Counselor: What do you feel when you read that to me--your freely chosen role as husband? Client: Well--1--1--certainly don't view it as a burden. It doesn't weigh on me heavily. Counselor: Do I see a man who is really trying very hard to discard the "role of husband," this freely chosen role? Client: I'm--I'm not desperately trying to shed that clothing. Not like I could. +At this point we stop to explore this blockage toward further intimacy. The blockage is toward himself as well as others. He admits he has clung to the roles of "father and husband." Pressing further we discover that these have indeed worn very thin, and are only "token roles" as he identifies them. +Client: Obviously I want to (wear the husband role), otherwise I wouldn't do it. But maybe a token gesture doesn't really take the place of me being there. +Counselor: What is a "token gesture?" What does it mean? +Client: It doesn't make me feel guilty or bad to view it as a token +gesture. Admittance of the truth as I'm sure it's perceived. +Counselor: "I'm discovering something about myself. In some way this freely chosen role of husband is a token gesture." +Client: Token gesture in the sense that it doesn't actually take the place of actually being there, raising our little girl ... +Counselor: What's lacking? Why not go on for ten years? +Client: I don't think anyone would go on for ten more years doing the same thing. Counselor: What would have to change in order to continue? Client: (Draws deep breath). I think--uh--interests would have +to be developed in order to share our lives, intimacy and common interests. I really don't think those can be achieved at this stage of the game --after twelve years. If it wasn't there after twelve years, nothing is there to make me think it will be there in the future. It's hard to even think of going back into that relationship and fulfill my needs. (Silence.) +Counselor: We have already established that, being human, we can't escape pain or avoid guilt. These can be important teachers, pointing to new meanings. You already have endured pain of loss, change, transition, and the guilt that comes because you can't go down two roads at the same time. (Here we enter a discussion about the hourglass of time, how the sand keeps falling through the narrow neck of the glass into the past, with meaning possibilities unfulfilled because of his indecisiveness.) +Client: I feel pain, guilt, frustration, all those feelings. I don't sleep well at night. I'm never quite free of them. +Counselor: Suppose the anxiety would say, 11l bump up against you, I'm dependent on you since I don't possess the freedom that you have. I might roll up and mash your foot, but I'm just a feeling, an object. You're the one who can run away from me. 11 +Client: Oh, that's true! The anxiety will be there as long as I let it be there. The anxiety will not go away by itself. It will necessitate action on my part. +Here we discover his center of freedom consciousness reveals to him. "I must choose responsibly, and my decisions will affect others. 11 Through self-distancing he begins to learn from his anxiety and guilt, the issue is now seen as one of freedom and responsibleness rather than of only avoiding pain. +We explore, through Socratic questioning, important episodes in his past when he experienced the anxieties of decision making. He reviewed two --when his mother died, and when he changed jobs --necessitating a decision on his part. He admits that he made appropriate and responsible decisions during both of these difficult times. +Counselor: It's hard for you to use the word trust --trusting your intuitions, your judgments, trusting that others and life do respond when you give your best in using your freedom. +Client: I have often put my trust in my decision, and it worked out. In my current situation I haven't developed that trust in myself. I don't know why. I need to. Maybe if I take that one step and let my trust take over--I really need to do that. I stand with both feet together, neither one moving forward. +Counselor: Don't you believe that some trusting energy that +served you at past forks in the road is still with you? Client: You mean, the same feeling that existed then exists today? Counselor: More than feeling. Trust is not a feeling as much as +it is a spiritual energy. "I can forge ahead!" Client: I had no choice then. No choice to vacillate. Counselor: Who said you had no choice? Client: Other forces. Counselor: Others would have closed doors on you. You were +limited by time to make your own decision. Client: Right. (Claps hands.) Had to make a decision, had to. Counselor: How was that different from what you face now? Client: Well I can put off and put off, avoid---. Counselor: In other words, now you can juggle things. Client: (Smiling) Absolutely! Counselor: So, if you play the clown and juggle things. Client: So right! So right! In fact, a very good friend who +knows about these events is amazed at how I can juggle +things. Counselor: What's it like, being a juggler? Client: (Laughs.) Well, it's frustrating at times. I vacillate. It's +painful, too. You know, people who know the situation, +uh--are amazed that I have been able to juggle this long. Counselor: Do you ever drop a ball when you juggle? Client: (Laughs.) The balls are dropping now, believe me. Counselor: But, you freely choose the role of juggler. Client: Right. (Grinning.) Counselor: It's your choice to be a juggler, you've discovered +33 +that. You put it out on the table, own it. +Client: I don't know if it's my basic choice but--uh--a juggler in +this situation, yes, is a good analogy. Counselor: You freely chose it. Client: I chose it to stay active as a juggler for fear of catching +one ball and the other dropping to the ground, and finding it painful, saying "Boy, why didn't I catch that one?" Just a fear. +Counselor: The pain-fear. A juggler has to rest. No juggler can keep it up, throwing things in the air. Client: (Laughs.) I've juggled it for a long time. Yeah. I know (seriously) that I have to do something. +Counselor: You may juggle with things, with oranges and apples, but when you toss people up into the air, it may change, as you call it, the "whole game." +Client: I don't view it as a game. It's just --I view it as inability to move forward at this point. Indecision. Created by fear and guilt. But I do know something has to be done. (Sighs.) +Counselor: Think about how long you can stand the strain of this juggling and what happens when you juggle people. The others are free too, they may quickly drop out of the game. You are sensitive, you have made difficult decisions in your life, and your history shows that when you do take a stand there is order and meaning in your life. We've discovered today that you are the freedom, not the fear or anxiety. Your choice needs always to be made in view of "To whom or to what am I responsible?" +Here we experience a man who chose a worldview held by many persons and taught in many philosophies, the view that "I am not free." Koestenbaum maintains that those who hold this view must ultimately admit that it is based upon determinism. The determinist refuses to accept the reality of an ambiguous and fluctuating universe with all its mystery. "Unless his experience can be interpreted as cause-and-effect sequences, he chooses not to understand it. "3, p. 325 +After two more counseling sessions Seth filed for divorce, affirmed safeguards to build a more healthy and honest relationship (intimacy) with his young adopted daughter, and to free himself for a more mature commitment by marriage to Donna. His pain and guilt led him to deeper intimacy with others and more respect for himself--a movement toward health. +All four steps used by logotherapists were applied: 1) Self-distancing: "I am not the pain or guilt, I can let them teach me important messages about intimacy." 2) Modification of attitudes: "Pain and guilt cannot be avoided, neither can responsibleness. If I let others make choices for my life, I do not live. Healthy, intimate living is lived with a 'healthy tension.' +3) Orientation toward meaning.The client became better grounded in the actualities of his existence. He moved from mere "tokens" of existence to freely chosen roles that enabled him to be himself with more respect and openness. 4) Selftranscendence--beyond selfish, personal aims, beyond guilt and pain to genuine and freely chosen commitments, to a creative experiencing the value and meaning of intimacy in new ways. +The Silver Cord was not Broken +Glen, a gifted, middle-aged teacher struggled against depression and self-deprecatory attitudes. The struggle toward intimacy was experienced on two levels: the encounter with me, the therapist, and experiencing closeness and intimacy in his own relationships. His feelings of negativity and despair overshadowed what he "knew" he ought to do. He said: "Fear does not always rule my life, but I am frequently attacked by it. I know what to do, but am afraid to do it." +Logotherapists will recognize the healthy disclosing sentence, see it as a "logohook," and identify it as a healthy thrust of consciousness. We begin the self-distancing. +Counselor: The part of you that knows and your feelings are two different things. You do choose --you do make a difference. You accomplish a lot. You feel fear, sadness, limitations, but a part of you knows how to take a stand toward your feelings. +Client: Sometimes I'm afraid to take another step, not sure whether it will make sense. +Counselor: Let's look at your past. If your past is like a spider's web --what kind of web do you spin? It seems loaded down with the jewels of achievement, experiences, relationships. +Client: (Weeping). Yes, I would say so. Counselor: No one can take them away from you. Based on this kind of past, what do you learn from looking at it? +Client: Well, I learn that even though I really feel down and deserted, there is a part of me resting up, getting ready to take another shot at it later, maybe tomorrow. +Here the logotherapist recognizes the "healthy part," what Fabry calls the "medicine chest of the human spirit."1 +Glen's past also reveals the experienced and stored meanings of intimacy. We can experience them retroactively. They are still very real, behind the depression and despair. In spite of the despair he says, "I still have hope," which is spiritual energy prompting him toward meaning. Counselor: You are a survivor. +Client: (Sighs and smiles) Well... I think that's true. How did I come out? Certain people cared about me. I experienced the nurturing of caring people which led me to believe that another reality was higher than the one I experience. A priest in high school took personal interest in me, a bishop treated me tenderly when my father brought me to church and presented me as a liar, he accepted me, was gentle with me. +Counselor: He genuinely cared for you. Instead of criticism and judgment, you experienced acceptance. Client: (Tears) Yes. (Tells of others who manifested regard and interest in him. +Next he talked about something quite personal regarding his need for closeness with others. He recently experienced rejection from someone who was attempting to help him. He was told "you want too much," which left him hesitant and selfdoubting. He shared a dream, providing a clearer picture of what he experiences inwardly. Client: I see my and my neighbor's land. I have no electricity. +I want to plug into a fence post on the line but am afraid he will come and say "that's enough." He'll get irate. In another part of the dream I'm looking at my own power package (puts hand on chest), it's all rusted and corroded inside. I'm afraid to put my hand in it for fear I will get electrocuted. +Here, the fear of others and the lack of trust in himself are revealed. He even wonders if he will be cut off from me. +Counselor: Let's go to the pain. It's almost as if you say at each session, "I need someone to understand my pain. There is a part of me that hurts so badly that I wonder if there is a person who can understand." (Long silence. He weeps.) +36 +Client: I'm tom between talking about that pain and the pain I experience now. I'm new here and I feel hesitant with you. +Counselor: Stay with the pain of the present. +Client: I'm a little nervous. I feel like you are pushing me to get into things. I appreciate that. I appreciate that you recognize an issue instead of letting me wander in the marshes. . . but. . . I am cautious. I feel like I've been burned a lot. +Counselor: It makes sense to be cautious. I will not go any faster than you are able to proceed. We'll walk together. +Client: When I think of coming here for therapy, I take a very detached attitude, "Well, I'll try it: If he doesn't work out, I have my list of nine others." +Counselor: You are entirely correct. You don't know me well and it's appropriate to care for yourself and be cautious. We've had only three sessions. We can proceed cautiously, wade in only two or three inches. In half an hour you have given me so much, the dream that gives a picture into your psyche and your struggles. What do you think the dream means to you? Client: I do hesitate and fear getting help from others. Afraid I'll be told "you want too much." Afraid my own works (in his power pack) are all rusted and corroded, lethal. I worry about killing myself. Tried it once. (Shows wrist and scars.) Then I think of my family, my responsibilities. (Pause.) I feel my anger is dangerous. I was very angry when I was a child. I guess that was when I got beaten up. The pain I feel is the pain of no meaning at the center, an emptiness (weeps). Is there no place for me in the world? I cannot survive without understanding... I feel disapproved of. Counselor: Regardless of the feelings you've just shared with me, there were persons who listened to you, were gentle with you, shared your pain. That message came through. (He weeps.) You can truly say I've had love in my life and even now you can say "I am loved. There are those who care for me." In spite of a world that sometimes appears as a jungle and dog-eat-dog, you have experienced gentle people. You are sharing your values with me. You reject much of the brutality and abuse in the world. You don't want to live by attacking the jugular vein. Client: But I do it. I have a killer instinct. When I get angry at someone I'm afraid I will devastate that person. I +know others suffer from the same malady It's not always under control, or it's controlled so much it's turned against myself. +Counselor: You have shown me that in spite of the feelings you +have, the anger, your life has meaningful relationships and +you fulfill tasks that bring meaning. +Client: Yes, I believe so. +Counselor: In spite of the feelings, you are in the driver's seat most of the time, not the feeling. +Client: Yes. I think so. In my teaching I'm trying to be a good role model, also as father and husband. +Counselor: Those are the areas where you are special, unique. Last week you told me the beautiful experience of sharing and integrating a play with a Teasdale poem, it was a wonderful experience with your students. · It made a difference to them. Look at the potential that exists when you plant such seeds. How beautiful that was. Only you can teach like that. (He weeps.) Also you were the one who called a meeting to explore ways of better understanding and reaching your students, in spite of your pain. (He weeps.) So in spite of the dream, saying the machinery is old, "my power plant is rusty," the current is getting through, there is enough energy flowing through you to others, you rise above your pain and past neglect. +Client: (Weeping.) A silver wire reaches from my center out into the green woods, but I fear I myself am the destroyer. . . I fear I will be the shark. +Counselor: Maybe the very fact that you say you fear you will become the shark points out how much you value treating others with gentleness and respect. Your fear even enlightens a value ofthe silver wire showing you how you want to live your life. +Client: Yes. Yes. I didn't see it so clearly before. Thank you! Thank you! (Weeps.) +This vignette illustrates self-distancing, interwoven in the fabric of our sessions. There is a constant dereflection from dispiritedness and negativity toward spiritual strength and will to meaning, toward self-acceptance and intimacy with others. +"Talk about hope, I heard you say, 'I still have hope.'" "Your mention of hope shows you have survived. 11 "Tell me the positive about yourself, I am ____ 11 "You risked sharing with others and emerged stronger." +"You discovered that you are not alone." +"What do you hope to accomplish?" +"Regardless of the feelings you've shared... you can truly say 'I've had love in my life and .. .I am loved."' +"You are sharing your values with me...you reject much of the brutality of the world." +"You have shown me that in spite of the feelings you have, the anger and pain, your life has meaningful relationships and you fulfill tasks that bring meaning." +"The current is getting through, there is enough flowing through you to others. You rise above your pain and past neglect." (Presenting "the defiant power of the human spirit.") +"Your fear even enlightens a value of the silver wire showing you how you want to live your life. +Always, always, clients are affirmed in their positive and courageous stands amidst all their suffering. From this one session I knew that this client was on the road to recovery, transcending his feeling of meaninglessness and depression. +The logotherapy approach in counseling clarified for him 1) his rich treasure of meaning through intimacy already stored up, 2) these meanings are present though clouded by despair, 3) self-detachment and deretlection help 'him identify his spiritual care -"I have hope" -and "the silver wire that reaches from my center out into the green woods," and 4) his intact values, "I am not a shark, but one who can experience love and also care for others." +JAMES D. YODER, PhD., is a psychologist in private practice, Kansas City, MO, and regional director of the Viktor Frankl Institute ofLogotherapy. +REFERENCES +1. +Fabry, J. B. The Pursuit of Meaning. Berkeley, Inst. of Logotherapy Press, 1987. + +2. +Frankl, V. E. The Unheard Cry for Meaning. New York, Simon and Schuster, 1978. + +3. +Koestenbaum, P. The New Image of the Person. Westport, Conn., Greenwood Press, 1978. + + +Psychopathology and Life Purpose +George B. Kish and David R. Moody +Frankl2,3 and Maddi10, among others, have theorized that a lack of meaning and purpose can cause psychopathology. Frankl's logotherapy is to help patients find direction in lives, thereby removing the source of their psychopathology. +Crumbaugh and Maholick's1 Purpose in Life test (PIL) was simplified by Hutzell for his logoanalytic treatment program for alcoholics at the Knoxville, Iowa, VA Medical Center.5,8 He calls his measure the Life Purpose Questionnaire (LPQ).4 It is easier to understand and fill out than the PIL. Since research has shown that LPQ can reasonably substitute for the PIL (r's +range from .60 to .84),6 we used it in our study. We thought it necessary, however, to further validate the LPQ. Our study provides such validation. +Hutzell and Peterson7 also constructed a short MMPIderived scale to measure existential vacuum and the depression correlated with it. They produced the Existential Depression scale (ExD), consisting of 11 MMPI items which correlated with the PIL and showed significant changes in patients treated with logotherapy. We used the ExD scale as part of our evaluation tools. To examine the scale's construct validity and clinical meaning, we determined correlations with other clinical instruments (MMPI and Shipley Institute of Living Scale). These correlations are reported in this article. +We hypothesized that psychopathology of a wide range of diagnoses would be negatively correlated with meaning and purpose. This hypothesis is based on common sense and on the writings of Frankl, Maddi, and other logotherapists. For example, the hopelessness frequently seen in depression would markedly inhibit purpose in life and future-oriented thinking. +Hutzell found PIL to be positively correlated with life satisfaction. Presumably, psychopathology would be negatively related to life satisfaction and be reflected in our hypothesized relationships between pathology and lack of meaning. +48 male patients in the Alcohol Dependency Treatment Program (ADTP) of the VA Medical Center in Salem, Virginia, were tested. Their mean age was 45.0 years (standard deviation of 11.3) and their mean educational level was 11.6 years (standard deviation of 2.2). +The ADTP is a 28-day program following a 5-to-10 day detoxification. Patients were routinely tested at the end of the +first week of the ADTP program. Therefore, they had been sober an average of two weeks before their test. Kish ~ found that organic effects of alcohol disappear on the average, by 10 to 14 days of abstinence. +We used the Shipley Institute of Living Scale (a short test of intelligence), the MMPI, the LPQ, and the ExD.), All tests, except the MMPI, were administered in one sitting at 2:30 to 3:30 p.m. The patients were given until the following morning to complete the MMPI. We cautioned them not to collaborate with others beyond asking the meaning of words. +After scoring the tests, we calculated means and standard deviations for all measures, and computed Pearson Product Moment correlation coefficients between the different tests. +In addition to the standard clinical scales of the MMPI, we scored the test for five additional scales: +• +The Welch Anxiety Scale (Welch A) measuring discomfort. + +• +The Welch Repression Scale (Welch R) measuring defensiveness. + +• +The Baron Ego Strength Scale (Baron ES) measuring the degree of prognosis in conventional psychotherapy. + +• +The MacAndrew Alcoholism Scale (MacAndrew) measuring problems frequently experienced by alcoholics. + +• +The Keane Post Traumatic Stress Disorder Scale (PTSD) which distinguishes veterans suffering from post traumatic stress disorders from a general psychiatric population. + + +Results +The Pearson Product Moment intercorrelations between LPQ, ExD and the other variables are presented in Table 1. +The ExD and the LPQ correlate negatively (-.64), as we might expect from two scales that are scored in opposite directions. Other relevant observations are as follows: +Among the correlations for the LPQ, there are no significant correlations with the Shipley variables. There are, however, numerous significant correlations with the scales of the MMPI. Significant positive coefficients emerged between the LPQ, K, Barons ES, and age of subject. +Significant negative correlations were found with scales measuring a variety of types of psychopathology: F, D, Pd, Pa, Sc, Si, Welch A, and PTSD. +Regarding the ExD, we found significant negative coefficients with scales measuring positive characteristics, such as LPQ, K, and Ego Strength. These tend to mirror the coefficients for the LPQ except for the size of the coefficients. +Positive correlations were found between the ExD and the following types of pathology: F, D, Pd, Pa, Pt, Sc, Si, Welch A, and PTSD. +The mean score on the LPQ for the alcoholics was 10.9, with a standard deviation of 4.45. For the ExD the mean score was 4.4 with a standard deviation of 2.6. These scores suggest for alcoholics a lack of meaning and purpose (or at least an indeterminate meaning and purpose) and a moderate degree of existential depression. +Significant relationships were found between both LPQ and ExD and the Masculinity-Feminity scale of the MMPI. The directions of the coefficients suggest that a feminine interest pattern in the male alcoholics tested is associated with low meaning and purpose. +Table 1. Intercorrelations between the LPQ and ExD scales and the four scales of the Shipley, 18 scales of the MMPI, and age and education +LPQ ExD Ship V Ship A Ship IQ +LPQ 1.00** -.64** .01 -.11 .00 +ExD -.64** 1.00** .21 .30* .24 +Ship CQ L F K Hs +LPQ -.12 -.09 -.54** .37** .01 +ExD .18 -.01 .54** -.29* .15 + +D Hy Pd MF Pa Pt +LPQ -.48** -.09 -.44** -.29* -.29* -.47** +ExD .55** .27 .55** .37** .52** .63** + +LPQ ExD Sc -.43* .54** Ma -.1 2 .18 Si -.55 ** .53** Welch A -.58** .69** Welch -.06 .15 R +LPQ ExD BaronEs .32* -.45** MacA .02 .12 PTSD -.66** .78** Age .42** -.43** Ed .04 . 18 + +Note 1: * = p < .05, r > .28; ** = P < .01, r > .36; 2 tailed t test with 46 degrees of freedom Note 2: The letters L, F, K, Hs, D, Hy, Pd, MF, Pa, Pt, Sc, Ma, and Si denote a variety of types of psychopathology. +The LPQ shows no significant relationship with the Shipley intelligence scales while the ExD shows positive trends plus one significant correlation with the Shipley Abstraction score. This somewhat puzzling finding is discussed below. +Discussion +Interpreting these findings, we must consider their correlational nature. From such data we cannot conclude causality. We can only conclude that, f. j., a good sense of life purpose is accompanied by a lesser degree of psychopathology but not that one caused the other. +Causality is an important question. One could argue that individuals with serious psychopathology are incapable of pursuing meaningful goals and purposes beyond trying to overcome their psychopathology: Their psychopathology interferes with the discovery and pursuit of meaningful goals. +Conversely, one could argue that the absence of meaning +and purpose will generate psychopathology. Authors who have written on this subject11 have suggested that neurotic symptoms would arise from existential vacuum. Rarely, however, have such writers suggested that existential vacuum would be related to the broad range of psychopathology indicated by our findings.It is more valid to think of clusters of measures indicating neurosis etc. than to think of each measure as indicating a specific syndrome. Clearly, our findings indicate that low life purpose is related to neurotic (D, Hs, and Hy), psychotic, (Pa, Pt, Sc, Ma) and sociopathic (Pd) variables. +An interesting finding is the small but significant relationship with the Masculinity-Femininity scale of the MMPI. Our alcoholic population was high-school educated and mostly rural, with a rather macho value system. Apparently, people with a more feminine interest orientation experience some psychic discomfort about this. Perhaps these correlations suggest a confusion about values in these men which weaken their sense of life's direction and meaning. Further research is needed to verify this speculation. +As to age, one might expect that youth are still trying to define their lives while the mature have established meaningful definitions. This expectation is confirmed by our findings that the young have more extreme scores indicating meaninglessness and existential depression. +As mentioned, the LPQ and ExD are negatively related. The coefficient of -.64 indicates a fair degree of similarity in what they measure. A correlation of this size of correlation +43 +indicates about 42% of common variance but leaves 58% unaccounted for. The depressive emphasis may account for part of the difference and also for the finding that the ExD are larger than the LPD coefficients. This suggests that this scale is tapping the common symptom of depression found as part of such syndromes as paranoia, psychasthenia, and schizophrenia. +The tendency for a positive correlation between the Shipley variables and the ExD is puzzling. It may suggest that those with higher intelligence (particularly abstract intelligence) are more likely to suffer existential depression and meaninglessness. Perhaps it takes some degree of intelligence to experience existential vacuum and consequent depression. But since the LPQ data do not support this conclusion, the correlations with the Shipley variable may be coincidental. +The relationship of the Keane PTSD scale with LPQ and ExD is interesting because the present data was also used to explore the clinical meaning of the PTSD scale. 11 This study found that the PTSD scale appeared to be a composite measure of psychopathology reflecting the degree of anxiety, depression, conflict and general psychopathology reported by those tested. The rather large correlation between this PTSD scale and LPQ and ExD leads to the conclusion that lack of meaning and purpose is related to a wide variety of psychological syndromes rather than to any specific diagnosis. +DAVID R. MOODY, Ph.D. is chief of the Alcohol Dependency Treatment Program (ADTP) of the V.A. Center, Salem, Virginia. GEORGE B. KISH, Ph.D. was the clinical psychologist on this unit, and is now program consultant. +REFERENCES +1. +Crumbaugh, J.C. and L.T. Maholick, Manual of Instructions for the Purpose in Life Test. Munster, Psychometric Affiliates. + +2. +Frankl, V.E. The Doctor and the Soul. New York, Knopf, 1960. + +3. +____. The Will to Meaning. New York, World Pub. 1969. + +4. +Hablas, R. and R.R. Hutzel I. "The Life Purpose Questionaire." In + + +S.A. Wawrytko (ed.), Analecta Frankliana. Berkeley, Institute of Logotherapy Press, pp. 211-215, 1982. +5. +Hutzell, R.R. "Logoanalysis for Alcoholics." Intern. Forum for Logotherapy, 1, 40-45, 1984. + +6. +____. "Meaning and Purpose in Life: Assessment Techniques of Logotherapy." The Hospice Journal, 2.,_ 37-50, 1987. + +7. +____, and M.S. Peterson. "An MMPI Existential Vacuum Scale for Logotherapy Research." Intern. Forum for Logotherapy, .8., 97-100, + + +1985. +8. +___________. "Use of the Life Purpose Questionaire with an Alcoholic Population." Intern. Journal for Addictions, Z.L 5157, 1985. + +9. +Kish, G.B., J.M. Hagen, M.M. Woody, and L.L. Harvey. "Alcoholics Recovery from Cerebral Impairment as a Function of Duration of Abstinence." Journal of Clinical Psychology, .3.6., 584-589, 1980.11. + + +IO Maddi, S.R. "The Existential Neurosis." Journal of Abnormal Psychology, 72, 311-325, 1967. +11. Moody, D.R. and G.B. Kish, "Clinical Meaning of the Keane Post Traumatic Stress Disorder Scale." Journal of Clinical Psychology, (in press). +Memo +From: The Viktor Frankl Institute of Logotherapy To: Members and subscribers Re: Memorial Fund +The Institute has established a memorial fund to honor persons the donor wishes to remember as being meaningful to him or her. +A donation has been made by Barbara and John Sheldon, MD in memory of +Luther E. Grice A man whose life's activities exemplified meaningful living +Logotherapy in Behavioral Sex Counseling with the Developmentally +Handicapped +Dave Hingsburger +Inappropriate sexual behavior by developmentally handicapped (mentally retarded) individuals almost always results in referral for mandatory treatment,13 most often behavior therapy. Sexually acting-out behaviors are potentially threatening for both client and supporting agency. Such behavior takes many forms such as public masturbation, exhibitionism, inappropriate touching, excessive friendliness, pedophilia, and social incompetency. Professionals who provide residential or vocational placements for such clients,13,14 are concerned that the clients may lose community placement and the supporting agency be faced with adverse publicity. They therefore look for methods that deal with the behaviors quickly and efficiently. Patients are often referred to behavior therapists to design procedures that enable staff to quickly eliminate the problems.12 Sexual behaviors, then, are seen like behaviors such as aggression and noncompliance that can be eliminated.18 +The aim is the systematic application of behavioral procedures which will effectively reduce the problem. Examples are punishing behavioral techniques which range from timeout19 to contingent squirts of lemon juice! for sexual behaviors as benign as masturbation.This application looks more like persecution than programming. The punitive focus of the programs reflects the general attitude toward the issue of sexuality and the retarded.12 +Behavioral technology remains the treatment of choice in dealing with problematic sexual behavior, not so much because the treatment is superior but because more traditional insight therapies are not considered suitable.15,20 Yet, to see intimate +human behavior as reducible to stimulus response patterns seems cold and mechanistic when placed next to society's view of human relationships. Society elevates the behaviors and patterns of human sexual relationships to the realm of meaning, morality and even spirituality.2,20 Thus in direct counseling with mild to moderately handicapped clients, the behavioral therapist faces the quandary of discussing behavior in societal but nonoperational terms. Yet, these are the terms which can help clients to understand and commit themselves to the treatment plan. +Logotherapy offers both a philosophical and psychological approach to human behavior applicable to both sexual counseling and behavioral programming. Logotherapy's main tenet is a belief that the primary motivating force in humans is striving for meaning. Fulfillment of meaning and actualization of values is given precedence over simple gratification of basic drives or adaptation to the environment.4 Logotherapy does not ignore psychological drives or environmental effects, but adds the dimension of meaning to the therapeutic session. This philosophy, to be viable in treatment, meets four basic criteria and provides practical therapeutic applications. +Respect for Patient +The first and most basic criterion is respect of persons with a developmental handicap (mental retardation), seeing them as capable of meeting meaningful treatment goals. Not many in psychology apply the relatively esoteric goals of meaning and values to the mentally retarded, or see such goals as appropriate. In contrast, Frankl feels that these goals are applicable to everyone, and must be recognized in treatment for all. He states that to question the ability of the mentally retarded to achieve these goals is intellectual self-conceit.5 If we ignore these goals in treatment, then all that separates us from veterinarians is our clientele.9 +Nondirective Approach +The second criterion is that the treatment be nondirective. One of the inherent dangers in dealing with meaning, value and spirit is that the personal bias of the therapist will be a determining factor in a client's personal decision-making. This danger is heightened when working with the developmentally handicapped. As a result of years of systematic compliance training, they often are fearful of making decisions or expressing personal thoughts.3 They look to the therapist for leads in determining personal morals. Therapists need to be vigilant in leaving control with the client. Frankl insists that this is fundamental in counseling. Otherwise, the therapist becomes a preacher, and personal responsibility in finding meaning transfers from client to therapist.7 +Compatibility of Methods +The third criterion for logotherapy's viability in treatment is its compatibility with the behavioral treatment. While logotherapeutic existential analysis and behavioral learning analysis may seem strange bedfellows, they are not necessarily contradictory. They can work exceedingly well together, if the therapist using both methods recognizes their differing intents. Behavior therapy provides a framework for learning behavior to better adapt to the environment. Behavioral philosophy does not provide an understanding of the behavior outside the discrete behavior analyzed. 10 Logotherapeutic analysis helps the therapist understand that discrete behavior and its meaning in the environment at large.8 Behavioral analysis looks at the behavior under a microscope, logotherapeutic analysis looks at it from a distance. This objective distance affects decisions made by the therapist about programming and type of intervention. +In fact, logotherapy may have more in common philosophically with behavior therapy than with psychoanalysis. When comparing logotherapy with psychoanalysis, Frankl perceives logotherapy as less retrospective and less introspective than its psychological counterpart. (Which may be one reason why it is applicable to clients with mental retardation.) Logotherapy is future oriented and grants the client the potential to behave in new ways, and to maximize new meanings.4 The purpose of logotherapy is not to replace behavioral or any other therapy but rather to rehumanize them.6 +Normalization +The final criterion is compatibility with the philosophy of normalization (social role valorization). Logotherapy predates normalization by twenty-three years. The first sentence of the revolutionary book Normalization states that behavior is determined by ideology (beliefs, attitudes, interpretations and values).21 This could have been a direct translation of logotherapy. +Frankl's time in a Nazi concentration camp possibly explains a similar view of liberated life for a person institutionalized solely on the basis of IQ. Frankl decried the grouping and labeling of individuals. To categorize +48 +people as 'types,' by their origins or as groups, is tempting because individuals no longer have to be dealt with as unique persons with values. They are reduced to a mere mass of depersonalized entities.9 +Applications to Sex Counselling +Without practical means of implementing logophilosophy, there is little purpose in adopting its psychological underpinnings. Logotherapy itself, apart from logotherapeutic existential analysis, can be used in several ways . +First, logotherapy demands that the therapist reevaluate the personal view held of the client. This is particularly true of clients who have already been stereotyped by society. A therapist with a preconceived view of a person because of some extraneous feature is likely to lose the ability to work with the human being behind the feature. Ifone sees retarded people as lacking in insight, one is unlikely to look for or find insight. If one regards retarded people as incapable of meaningful sexual relationships, one will ignore such possibilities in goal setting. There must be respect for the individuality, irreplaceability, and uniqueness of the client regardless of what societal group membership or what kind of stereotypes exist for that group. +Second, the therapist must guard against subtle direction of the client to the therapist's value base. Often clients have spent their lives acting in accordance to the values of whatever professional was in power. They must be freed of this bondage. There are four logotherapeutic recommendations for achieving this freedom. +Recognition of Personal Responsibility +The stance that no life is without meaning and that no one is replaceable leaves clients with heavy responsibility.4 The assumption of this responsibility is difficult for the non-handicapped client; for the developmentally handicapped, the issue of personal responsibility may come as a shock. For years, when clients with mental retardation sought psychiatric assistance, all need for therapy was attributed to the handicap rather than to the disruption of an inner emotive structure. This professional diagnostic overshadowing +49 +has often been accepted by the client and evidenced in sexual counseling. The idea of personal responsibility is often rejected by the client with assertions that the behavior results from the handicap and therefore the individual is freed from responsibility and is immutable to change. It is not uncommon for clients to explain away their actions by statements like, "I couldn't help it, I just don't understand things the way you do." These statements reflect learned attitudes rather than simple self pity. These attitudes need to be challenged through teaching that the handicap is a biological condition that does not denude them of moral responsibility. Yet the therapist must remain sensitive to the fact that the client may have little experience with either responsibility or freedom. +Participation in Goal Planning +Individuals need to assert themselves at the beginning of treatment. They must be present when the goals of therapy are discussed, and must have input when treatment is formulated.9 This is the best way to ensure program individualization. Clients must do more than simply participate in the goal plan; they must have their views and concerns respected for what they are rather than seen as evidence of pathology resultant from either sexual difficulties or faulty thinking due to the intellectual handicap.9 +Once determined, the goals need to be worked on, using the language of and examples from the client's life experiences.9 This will ensure that the client clearly understands the direction of and rationale for the treatment. It seems obvious that a person cannot achieve a goal which is not understood. The therapist needs to ensure that the client is not only physically present at the goal planning session but is also psychologically and intellectually present. This will allow the client to determine personal reference points and ensure that the goal is individuated and applicable within the client's present-day life experiences. +Because of years of behavior programming whereby clients received pleasurable consequences to desired acts, they may equate pleasure as the goal. This needs to be addressed. Logotherapy sees pleasure as a side effect to achievement of a real goal rather than the +50 +goal itself.6 This is important for the behavior therapist for it is the beginning of teaching the client that selfreinforcement in terms of pride and self-satisfaction are the most important forms of reinforcement and come only as a result of achieving an external goal. Often behavior therapy ends by the phasing out of external reinforcements without ensuring that the process has been internalized. +Training in Decision Making +Logotherapy sees a prime part of therapy as education toward the ability to decide.9 Obviously individuals without much experience in decision-making or who have been repeatedly punished as a result of independent decision-making are going to be hesitant. Clients must learn how to evaluate possible reactions to an action. Through reviewing past responses they can find appropriate alternatives and strategies for dealing with potential difficulties. This area of training demands the most from the therapist, because it is imperative that no form of leadership be taken. Clients are often desperate for therapist input in order to avoid making a decision. Facial cues, voice tones, body posturing are all possible ways of providing direction. Therapist neutrality along with assistance in learning objectivity through self-distancing are a major task of therapy. This can be a painful process, and humor through paradoxical images can relieve much tension. +In decision making, clients must learn to identify where choice exists. They need to learn that between stimulus and response is the freedom to choose. This freedom is the determinant of responsibility. Clients need to see both choice and freedom before they can understand responsibility. Clients not acknowledging control of their emotions will attribute actions to impulses that control them. They must learn to see themselves as adequate persons able to control their actions. +Delineation of Personal Values +During therapy, clients will determine their own moral stance on sexual and interpersonal behavior. This is an ongoing educational process that begins with the therapist presenting the issues to clients and determining +5 1 +whether they have the vocabulary of moral behavior. The lack of ability to give a rationale for situations being either right or wrong must be addressed. Clients often see their sexual misbehavior as 'wrong' because they were caught.11 ,12 This does not indicate callousness but rather a lack of understanding of their personal impact on the world. Clients must define for themselves a personal moral stance, an understanding that their actions have the power to hurt and heal. +Logotherapy is concerned with both 'being' and 'meaning' and therefore is both therapy and analysis.5 This analysis of the client's existence helps the therapist determine what to treat as well as whom to treat. Placing behavior in the context of meaning and value helps the therapist understand the client's needs. In sex counseling the most important segment of the analysis lies in the realm of human relationships.2 While overall meaning may be partially determined by community, individual meaning may be largely determined by communion with individuals within that community. +Research has shown that individuals determine meaning in life in various ways. 17 Three areas particularly relevant in sex counseling arise from meaning derived from human interactions. First is the existence of significant others, second the type of relationship, and third the means by which the relationship is sustained. The therapist needs to evaluate the nature of relationships the client has available. This is particularly important when working with the developmentally handicapped because they were often early in life separated physically or emotionally from their parents. Also, they may have been frequently punished or discouraged when entering relationships with handicapped peers. They may experience a 'peer void' wherein the only significant people in their lives are those paid to be there.15 Having clients name people in their lives with whom they feel close and affectionate, the therapist can graphically construct the clients' network of support. This is done by placing those who are closest in a circle immediately around the client's name, and other names further and further away, determined by the client's attachment. +The therapist needs to establish who the people are within the client's life and the form of relationship +52 +with each. The therapist looks for involvement with family, the existence of friends, the nature of relationships with staff, and the possible existence of present or past sexual partners. +Each of these various types of relationships are looked at on four levels.17 Commitment needs to be assessed by exploring the depth of feeling and the type of expectations the client has of the individual. It is important to discuss with clients their type of commitment to others. It is not unusual to find a client who has an on-going sexual relationship with another client but has an emotional commitment to staff rather +than to the sexual partner. One also finds great commitment to virtually nonexistent family members and practically none to roommates and work partners.16 The therapist, realizing the imbalance between the clients' expectations and reality, helps them learn to realign and reassess their world as it truly exists. This evaluation leads the therapist to the natural goal of therapy--to help clients reassess and reestablish commitment levels determined by reality. The therapist also needs to acknowledge areas where potential meaning cannot be actualized because no relationships exist outside of paid staff/client relationships. This acknowledgement leads to the teaching of skills necessary to establish friends and lovers. +Involvement with others needs to be assessed by determining how often and how long the clients are in contact with others. Individuals who live and work in close quarters with other developmentally handicapped people, have often many more verbal and physical contacts with staff. The goal of the therapist is to work within the system to establish a means for individuals to develop relationships with nonpaid friends, including but not limited to those who are also handicapped. This requires that the therapist be willing to work not only with the client but consult with group-home and agency staff to enable clients to establish meaningful sociosexual contacts. Seeing both client and staff as needing help and direction allows the logotherapist to empower a client with meaning and enable a service system to give room for the meaning to manifest itself. +Obligation is a necessary part of human relationships, especially for those we love. It is +53 +important that the therapist assess with the client the responsibilities of participating in a relationship. Many client/staff relationships are one-way, with the client the recipient of care and concern, and little expected in return except compliance. But reciprocity is the way individuals contribute their uniqueness in a relationship. Obligation in a relationship can be determined by probing what others have a right to expect from them, and what they themselves can bring to the relationship. Sharing non tangible aspects of personality and time is an abstract concept which may need both teaching and role playing for the client to fully understand. The therapist must determine whether the clients feel needed in any of their relationships, and whether they feel easily replaceable. The feeling of "replaceableness" often comes from seeing a number of others come and go within a group home with very little change in the dynamics of the home itself. This may lead to the assumption that their own departure would leave no void. +Future expectations of the various relationships need to be probed: what the clients expect from relationships, where they want to go with them, and how they would like to see them change in the future. Change can be frightening for those who have change occur around them without much control. It is important for clients to learn that relationships grow, develop, and mature, and that these changes are good and do not necessarily lead to abandonment. Clients need to be able to state how they would like to grow closer, redefine or even end present relationships. In some cases the therapist has the privilege of teaching a person how to dream. +Finally, the therapist needs to analyze how the various relationships sustain themselves between contacts. Adult relationships are maintained through physical contact, imagined and fantasized, or through 'hopeful contact' which includes information gathering and planning. Teaching clients to maintain contact, write letters (with assistance if necessary), make calls, or think of things to do, say, or see the next time they meet with the person, are all ways of keeping the relationship alive, even during times of separation. During these betweencontact times the clients can plan some reciprocal acts of kindness which they can enjoy from planning to doing. +An analysis of human relationships along these +54 +lines gives the sex therapist direction and context for determining the programming and the type of necessary training or support. Seeing sexuality in terms of meaningful contact with others as well as within the context of human relationships enables the therapist to use behavioral techniques humanely. +Summary +Logotherapy and existential analysis working with behavioral therapy, give the therapist the tools and framework for providing ethical treatment. Sexual behavior is viewed positively and works toward establishing relationships wherein clients can discover meaning. With relationships as a therapeutic goal, the job of therapist becomes more challenging and educative. The therapist works toward helping clients to have the resources to find meaning in their own lives, independent of all others. Without this emphasis, therapy tends toward restriction and denial of the right to relationships. Stringent behaviorism reduces a developmentally handicapped client to a behavioremitting entity rather than a whole human with the capability for finding meaning equal to all others. +DAVE HINGSBURGER is a sex therapist in Toronto, Canada. +REFERENCES; +1. +Cook, J.W., K. Altman, J. Shaw, and M. Blaylock. "Use of Contingent Lemon Juice to Eliminate Public Masturbation by a Severely Retarded Boy," Behaviour Research and Therapy, 16., 1978. + +2. +Edwards, J.P. Sara and Allen: The Right to Choose. Portland, Ednick Communications, 1976. + +3. +Flynn, M.C., D. Reeves, E. Whelan, and B. Speak. "The development of a Measure for Determining the Mentally Handicapped Adult's Tolerance of Rules and Recognition of Rights," Journal of Practical Approaches to Developmental Handicap, 2. (2), 1985. + +4. +Frankl, V.E. Man's Search For Meaning, New York, Touchstone Books, 1962. + +5. +____, Psychotherapy and Existentialism, New York, Pocket Books, 1967. + +6. +____, Will to Meaning, N.Y., Signet Books, 1969. + +7. +____. The Unconscious Go_d_.. N.Y., Pocket Books,1975. + +8. +____, "The Existential Vacuum," OISE audiotape, 1985. + +9. +, The Doctor and the Soul, Toronto, Vintage Books, 1986. + +10. +Geer, J.H. and W.T. O'Donohue. Theories of Human Sexuality, New York, Plenum Press, 1987. + +11. +Griffiths, D., D. Hingsburger, and R. Christian. "Treating Developmentally Handicapped Sex Offenders, The York Behaviour Management Services Treatment Program," Psychiatric Aspects of Mental Retardation Rev., .6 (12), 1985. + +12. +_________ ,D. V. Quinsey and D.Hingsburger. + + +Changing Inappropriate Sexual Behavior: A Community Approach for Persons with Developmental Disabilities. +Baltimore, Paul H. Brooks Pub., 1988. +13. +Haavik, S.F., K.A. Menninger. Sexuality, Law, and the Developmentally Disabled Person, Baltimore, Paul H. Brookes Publishing, 1981. + +14. +I-lingsburger, D., and D. Griffiths. "Dealing with Sexuality in a Community Residential Service," Psychiatric Aspect of Mental Retardation Reviews, i.(12), 1986. + +15. +Hingsburger, D. "Sex Counselling with the Developmentally Handicapped: The Assessment and Management of Seven Critical Issues," Psychiatric Aspects or Mental Retardation Reviews, .6 (9), 1987. + +16. +_____. Sex Counselling: "The Role or Rights, Responsibility and Relationships," Psychiatric Aspects of Mental Retardation Reviews, (in press). + +17. +Kundral<;, A. Attribution of Meaning to Life in Extremis, Unpubl. Doctoral Thesis, University of Toronto, 1982. + +18. +Mitchell, L., R.M. Doctor, and D.C. Butler. "Attitudes of Caretakers Toward the Sexual Behaviour of Mentally Retarded Persons," American Journal of Mental Deficiency, .8..1. 1978. + +19. +Paul, I-I.A. and J.R. Miller. "Reduction of Extreme Deviant Behaviour in a Severely Retarded Girl," Training School Bulletin, 67, 1971. + +20. +Rowe, W.S. and S. Savage. Sexuality and the Developmentally Handicapped, Queenston, Edwin Mellen Press, 1987. + +21. +Wolfcnsberger, W., Normalization, Toronto, N.I.M.R. Publication, 1972. + + +The Existential Vacuum in Bergman's "Scenes from a Marriage" +Jim Lantz +In Scenes from a Marriage, Ingmar Bergman 1 uses film to artistically explore the theme of meaninglessness and marital discord. The film initially depicts a narcissistic marital couple engaged in "purchasing" the appearance of meaning through a focus upon material security and accepting "as if" meaning by acting out the so-called "ideal" marriage described and prescribed in a popular women's magazine. In this prescribed ideal marriage, differences, conflicts and the stress of knowing and accepting both the real self and the real other are pushed out of awareness, especially in the film segment called "The Art of Sweeping Under the Rug." In sweeping such human differences and conflicts under the rug, the couple is also being extremely effective in insuring that the opportunity to discover real meaning based upon intimate knowledge is also denied and repressed. The appearance of meaning obtained through a focus upon material concerns and sweeping under the rug finally collapses in the segment called "Paula." +In "Paula," the husband Johan goes off to Paris with another woman, Paula, and Johan's wife Marianne experiences this event as the catalyst for the break-up of the marriage. Marianne, who does not initially have the security of an attachment with an other, first fully and directly experiences the pain of the existential vacuum and recognizes the sense of meaninglessness she feels in her life. The pain of the existential vacuum is so intense for Marianne that she physically attempts to keep Johan from leaving. She fails and is forced to find realistic methods of filling her vacuum other than by relying on the "appearance of meaning" projected onto a troubled marriage. +A year later, Johan, who now does not want a divorce, is faced with the pain which Marianne had first experienced previously in the "Paula" segment. As Johan clearly realizes that his affair with Paula cannot protect him from the pain of the existential vacuum, he again turns to Marianne and atempts to physically and violently force her to stay with him. He tries to defend himself from the pain of the existential vacuum by forcibly holding onto Marianne. +At the end of the film both Johan and Marianne are +married to new partners. Since they have become legally free of each other they paradoxically experience a new ability to comfort each other. Since they no longer try to use their "marriage" to cloud their awareness of the existential vacuum they can now comfort each other instead. At the end of the film, the final willingness of Johan and Marianne to comfort each other in the full awareness of the existential vacuum may well represent Bergman's personal willingness to admit that self-transcendence is a potential source of meaning in the face of the difficulties and tragedies of a real existential world. +Scenes from a Marriage is an especially useful and important film for the practitioner of marital therapy. The film does an excellent job of presenting a marriage in which both husband and wife use their troubled marriage to hide from the pain of the existential vacuum. Bergman's film can help the marital therapist remember that many couples utilize a focus upon an unhappy marriage to avoid awareness of a meaningless life. An awareness of this somewhat common unconscious motivation to maintain a disturbed marriage can be of great benefit to the marital therapist and/or logotherapist in his or her daily efforts to be of help. +JIM LANTZ, Ph.D. is an assistant professor at The Ohio State University College of Social Work and a diplomat in logotherapy. +REFERENCE +1. Bergman, I. Scenes from a Marriage. New York, Pantheon, 1974. +The Use of Meaning for the Elderly +Melvin A. Kimble and James W. Ellor +The application of logotherapy to older adults will require the therapist to get to know the persons and their lived world. Like in most therapeutic approaches, the logotherapist needs to establish the empathic bond by listening to the clients. In logotherapy, however, the types of questions may vary from other approaches. Three areas of inquiry are important for the discovery of meaning. +The first reflects the values of the individual. For persons who value kindness, meaning may be derived by being kind or receiving kindness. If the individual does not value hard work, or looks down on persons who do find meaning in working hard, then clearly the individual is not going to find meaning in this type of activity. Missinne notes: "The older person, who either chooses not or is not allowed to work, may be required to set aside the realization of creative values. Still, he or she has the opportunity to find deep meaning in the experiencing of beauty or loving relationships. If due to isolation and ill health, neither of these is possible, there is still what Frankl considers the highest achievement and, consequently, the deepest meaning available to an older person -the freedom of choosing one's response to this last challenge. How a person faces his own sufferings could be the highest value which will give meaning to his life. "3,p.46 +For Frankl, values are transmitted by traditions. He sees these traditions as decaying in modern society. "Only values which might be defined as universal meaning -can be affected by the decay of traditions... instincts are transmitted through the genes, and values through traditions, but meanings, being unique, are a matter of personal discovery. "2, p.41 Thus, Frankl feels that meaning can be discovered by individuals, even if they cannot identify their values. +The second area where logotherapy is different from many other approaches concerns the choices individuals make: "Man is not free from conditions. But he is free to take a stand in regard to them. The conditions do not completely condition him. Within limits it is up to him whether or not he succumbs and surrenders to the conditions. He may as well rise above them and by doing so open up and enter the human dimension."2, p.51 +As the therapist listens to the clients discuss their lives, it becomes clear that decisions have been made in response to the events and conditions of living on which they indeed have made choices.Helping clients understand these past choices may help them see where they can now have choices that can render them greater control over a more meaningful future. +The third area of inquiry relates to the fact that while Frankl acknowledges that there is an ultimate meaning, there is also meaning within each event. While one can summarize the collection of the meanings of these single events into a larger generalization of meaning, the smaller events have meaning as well. Because each experience for Frankl is unique, it may be difficult to find the conceptual continuity that pulls together an ultimate meaning. "We create meaning through choices and actions as we move through life, but we also discover meaning from many 'happenings' that come our way each day. 11 4,p.230 +As the therapeutic relationship moves from assessment to treatment,therapists may need to help clients discover meaning. This can be done in three ways: by creating a work or doing a deed; by experiencing something or encountering someone; and by the attitude we take toward unavoidable suffering. I. p.133 +Logotherapy offers a different way to look at the difficulties or events of suffering that happen in life. Frankl suggests that "the emphasis on responsibleness is reflected in the categorical imperative of logotherapy, which is: 'Live as if you were living already for the second time and as if you had acted the first time as wrongly as you are about to act now!'"1, p.131 In this change of perception the individuals move from seeing their fate as unalterable to seeking the meaning behind their suffering. Frankl does not suggest that "suffering is necessary to find meaning. I only insist that meaning is possible even in spite of suffering -provided that the suffering is unavoidable." 1. p.136. +The actual techniques used with older clients may include the Socratic dialogue, dereflection, paradoxical intention, the use of humor, and modification of attitudes. Each of these approaches helps older adults see new ways of examining the difficulties or hurts within their lives in order to discover the meanings that these events or feelings can have. It is important for older adults to see the possibility of finding meaning even if everyone they have ever known or cared about has died; to see the possibility of meaning even if they are suffering from incurable diseases. As Frankl notes, "unconditional meaning, however, is paralleled by the unconditional value of each and every person. It is that which warrants the indelible quality of the dignity of man. Just as life remains potentially meaningful under any conditions, even those which are most miserable, so too does the value of each and every person stay with him or her, and it does so because it is based on values that he or she has realized in the past, and is not contingent on the usefulness that he or she may or may not retain in the present." 1, p.176 +Gerontologists will find logotherapy an ally for assisting them in confronting the humanity of their clients at the deepest level -the level of meaning. The logotherapeutic tenet that selftranscendence is the essence of human existence opens the door to a deeper understanding of the human capacity to dedicate and commit oneself to something or someone beyond one's self. With its concept of dimensional ontology logotherapy provides creative interpretations of the ontological differences and anthropological unity of personhood.1, pp.136-140 It enriches the understanding of meanings and values, of freedom and responsibility, of conscience and commitment, of decision and responsibleness, of suffering and faith. +In its recognition of the holistic nature of human beings, logotherapy appeals to what lies beyond their psycho-physical nature. By emphasizing that they are not simply psychosomatic organisms, logotherapy introduces an understanding of personhood which affirms one's capacity to find meaning in every stage of life even in the midst of suffering and dying. +MELVIN A. KIMBLE, Ph. D. is professor of pastoral theology and ministry at the Luther Northwestern Theological Seminary, Minneapolis, Minnesota. JAMES W. ELLOR, D. Min., A.M., CSW, ACSW is associate professor, Department of Human Services, National College of Education, Minneapolic, Minnesota. +The above article is a shortened version of parts III and IV of Logotherapy: An Overview, published by the National College of Education, Evanston, Illinois and distributed by the American Society of Aging at its Annual Conference, March 1989. +REFERENCES +1. +Frankl, V.E. Man's Search for Meaning. New York, Washington Square Press, 1959. + +2. +____. The Unheard Cry for Meaning. New York, Washington Square Press, 1978. + +3. +Missinne L.E. and J. Willeke-Kay. "Reflections on the Meaning of Life in Old Age," J. of Religion and Health 1(4), 1985. + +4. +Reker G.R. and P.T.P. Wong. "Aging as an Individual Process" in The Emergent Theories of Aging. N.Y., Springer Publ. Co., 1988. + + +The International Forum for LOGOTHERAPY +JOURNAL OF SEARCH FOR MEANING \ No newline at end of file