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+Volume 13, Number 1 Spring 1990 
+Dear Professor Fran kl: 
+It is a pleasure to send you greetings on such an auspicious occasion as your 85th birthday. We wish you good health, ongoing joy with your family and friends, and continuing success among your circle of colleagues and admirers. 
+I am taking this opportunity to thank you for your lasting contributions to humankind. Your work has found applications in many fields with many people in many situations and, as this issue of the Forum illustrates, in many parts of the world. Using logotherapy with children and adults has demonstrated that both theory and application have become invaluable tools in practically all life situations. Can there be a greater satisfaction than to witness the fruit of your labor? 
+The Board of Directors of the Viktor Frankl Institute joins me in sending you our heartiest congratulations and warm wishes. 
+Cordially, 
+
+Bianca Z. Hirsch, Ph.D., President Viktor Frankl Institute of Logotherapy,Berkeley 
+CONTENTS  
+Milestones in the History of Logotherapy . . . . . . . . . . . . . . . . . . .  3  
+Stephen S. Kalmar  
+Argentina:  
+The Meaning Crisis in Affluent Society . . . . . . . . . . . . . .  7  
+J.V.M. Romero, S.M.Munton, M.A ..Parayola, A.Saenz  
+Australia:  
+Logotherapy in Reproductive Medicine . . . . . . . . . . . . . . .  15  
+Christopher S.E. Wurm  
+Austria:  
+Existential Analysis Psychotherapy . . . . . . . . . . . . . . . . .  17  
+Alfried Llingle  
+Canada:  
+Two Poems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  20  
+Tom McKillop  
+Germany:  
+Suffering and Religiosity . . . . . . . . . . . . . . . . . . . . . . . .  21  
+Karl-Dieter Heines  
+Did You Know You Just Gave a Logotherapeutic Address?..  22  
+Walter B&:kmann  
+Self-Help and Crisis Intervention . . . . . . . . . . . . . . . . . . .  24  
+Elisabeth Lukas  
+Israel:  
+With Viktor Frankl in Jerusalem . . . . . . . . . . . . . . . . . . .  32  
+Mignon Eisenberg  
+Italy:  
+
+Educational Aspects in the International Forum . .......... 34 Eugenio Fizzotti 
+Japan: 
+Work and Play in Education ....................... 38 Hiroshi Takashima 
+Nigeria: 
+The Use of Pictures in Logotherapy .................. 39 Charles Okechukwu I wundu 
+Norway: A "Case History" from Frankl's Files .................40 Contributed by Bjarne Kvilhaug 
+Mexico: 
+V. Frankl and V. Havel . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Guillermo Pareja Herrera 
+Poland: 
+Universal Truths ...............................49 Kasimierz Popielski 
+South Africa: 
+A Lesson for me and South Africa ................... 51 Patti Havenga 
+Sweden: 
+Investigation of the Logotest in Sweden . . . . . . . . . . . . . . . 54 John Stanich and Ilona Ortengren 
+United States: 
+A Modified Logochart for Youth .................... 61 Bianca Z. Hirsch /The Story of a Bestseller ......................... 64 Robert C. Leslie The Evolution of Noos . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Joseph Fabry The Unemployed Appalachian Miner's Search for Meaning ... 71 Richard W. Greenlee Meaning and Midlife Crisis . . . . . . . . . . . . . . . . . . . . . . . . 76 Karen V. Harper 
+The International Forum for 
+LOGOTHERAPY 
+JOURNAL OF SEARCH FOR MEANING 
+Volume 13, Number 1 Spring 1990 
+Dear Professor Fran kl: 
+It is a pleasure to send you greetings on such an auspicious occasion as your 85th birthday. We wish you good health, ongoing joy with your family and friends, and continuing success among your circle of colleagues and admirers. 
+I am taking this opportunity to thank you for your lasting contributions to humankind. Your work has found applications in many fields with many people in many situations and, as this issue of the Forum illustrates, in many parts of the world. Using logotherapy with children and adults has demonstrated that both theory and application have become invaluable tools in practically all life situations. Can there be a greater satisfaction than to witness the fruit of your labor? 
+The Board of Directors of the Viktor Frankl Institute joins me in sending you our heartiest congratulations and warm wishes. 
+Cordially, 
+
+Bianca Z. Hirsch, Ph.D., President Viktor Frankl Institute of Logotherapy,Berkeley 
+CONTENTS  
+Milestones in the History of Logotherapy . . . . . . . . . . . . . . . . . . .  3  
+Stephen S. Kalmar  
+Argentina:  
+The Meaning Crisis in Affluent Society . . . . . . . . . . . . . .  7  
+J.V.M. Romero, S.M.Munton, M.A ..Parayola, A.Saenz  
+Australia:  
+Logotherapy in Reproductive Medicine . . . . . . . . . . . . . . .  15  
+Christopher S.E. Wurm  
+Austria:  
+Existential Analysis Psychotherapy . . . . . . . . . . . . . . . . .  17  
+Alfried Llingle  
+Canada:  
+Two Poems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  20  
+Tom McKillop  
+Germany:  
+Suffering and Religiosity . . . . . . . . . . . . . . . . . . . . . . . .  21  
+Karl-Dieter Heines  
+Did You Know You Just Gave a Logotherapeutic Address?..  22  
+Walter B&:kmann  
+Self-Help and Crisis Intervention . . . . . . . . . . . . . . . . . . .  24  
+Elisabeth Lukas  
+Israel:  
+With Viktor Frankl in Jerusalem . . . . . . . . . . . . . . . . . . .  32  
+Mignon Eisenberg  
+Italy:  
+
+Educational Aspects in the International Forum . .......... 34 Eugenio Fizzotti 
+Japan: 
+Work and Play in Education ....................... 38 Hiroshi Takashima 
+Nigeria: 
+The Use of Pictures in Logotherapy .................. 39 Charles Okechukwu I wundu 
+Norway: A "Case History" from Frankl's Files .................40 Contributed by Bjarne Kvilhaug 
+Mexico: 
+V. Frankl and V. Havel . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Guillermo Pareja Herrera 
+Poland: 
+Universal Truths ...............................49 Kasimierz Popielski 
+South Africa: 
+A Lesson for me and South Africa ................... 51 Patti Havenga 
+Sweden: 
+Investigation of the Logotest in Sweden . . . . . . . . . . . . . . . 54 John Stanich and Ilona Ortengren 
+United States: 
+A Modified Logochart for Youth .................... 61 Bianca Z. Hirsch /The Story of a Bestseller ......................... 64 Robert C. Leslie The Evolution of Noos . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Joseph Fabry The Unemployed Appalachian Miner's Search for Meaning ... 71 Richard W. Greenlee Meaning and Midlife Crisis . . . . . . . . . . . . . . . . . . . . . . . . 76 Karen V. Harper 
+A Logotherapy and Cognitive Therapy 
+Center in Dallas 
+Manoochehr Khatami, D. Doke, and R. Boyer 
+In our psychiatric department at St. Paul Medical Center, Dallas, we primarily use cognitive and logotherapy in individual, couple, or group therapy. 
+We have a Center for Bio-Behavioral Medicine, an adult psychiatric unit, a substance abuse program, a dual diagnose program, and a psychiatric care unit. All these facilities provide inpatient psychiatric care. In addition, we also have an outpatient program and a day program for treating chronic pain. We now are establishing a partial hospitalization program for outpatient psychiatric clientele. Individual therapies are applied on a daily basis for inpatients or on a weekly basis for outpatients. Group therapy is offered daily for inpatients. 
+Cognitive therapy is effective for depression. Logotherapy is an extremely helpful supplement for patients with depression and other psychiological problems. It is primary therapy for patients suffering from unavoidable blows of fate, or those exploring their personal attitudes, freedom of choice, and responsibility in an attempt to disover meaning in life. Combining these two techniques in the logochart has been helpful for all these different psychiatric syndromes. 
+Patients receive a complete psychosocial and psychiatric assessment. The diagnosis is made according to the DSM-111-R, and the appropriate treatment is recommended -inpatient, outpatient, or day program. Most patients, in addition to psychotherapy, receive psychopharmocological intervention. 
+Type of program, length and goals of treatment depend on the patient's diagnosis and clinical needs. A weekly multidisciplinary team meeting brings together a psychologist, social worker, occupational therapist, psychiatric nurse, recreational therapist, and psychiatrist. They set the treatment plan and review the weekly progress. A weekly supervision conference views the video tapes of the patient's therapy sessions, providing feedbeck to the therapists. The psychiatrist is the team leader and primary doctor for the management of the patient. Family members are actively involved in the program and participate in the treatment of the patient. 
+The educational program includes in-service training, lectures by psychiatrists, a quarterly psychiatric forum, and an annual symposium dealing with psychiatric diagnoses and 
+83 
+an annual symposium dealing with psychiatric diagnoses and treatments. Family-practice residents rotate in the psychiatric department during their training. Our methods are adjusted to . the patient's clinical needs, the main therapeutic techniques 
+being logotherapy, cognitive therapy, and the logochart. 
+In the following case study the depression was 
+psychogenic and reactive. The psychogenic part was anchored in 
+automatic thought processes. The reactive part was the result of 
+loss of job. Both aspects were treated with help of the logochart 
+and career counseling based on what the logochart discovered as 
+authentic thought processes. 
+Jeff was depressed about his economic situation. He 
+could not buy his children the clothes he would have liked. He 
+was afraid he might lose his house. He felt anxious and guilty 
+because he believed that to live fully he had to have a nice home 
+and stylish clothing. 
+Through Socratic dialogues Jeff came to realize that 
+these reactions were prompted by drives for prestige and 
+power widely accepted by his peers. He was challenged to shift 
+his values toward those that were more authentically his and 
+not dictated by his environment. His children wore clean 
+clothes even though they didn't have $50 designer jeans. He 
+realized that his emphasis on materialism set a model for his 
+children to learn a philosophy that overvaluated things. He 
+became aware that his house had caused him constant struggle 
+to make payments and that he had lived in fear of losing it. He 
+decided he wanted to start living by values that seemed 
+important to him as a unique person, rather than living by the 
+values of others. He prepared to sell the house and looked for a 
+less expensive home although this might affect his social status. 
+Jeff's depression resulted from an overemphasis on the 
+importance of possessions and social approval. These values 
+represented his automatic self, responding automatically to 
+crises and situations. Logotherapeutic dialogues helped him see 
+his authentic self that was reaching for values meaningful to 
+him. When Jeff recognized the importance he was placing on 
+material things and how that was causing him to experience 
+depression, guilt, and anxiety, he was able to self-distance 
+himself from his situation. In the dimension of his spirit, his 
+authentic self found new responses in a more genuine and caring 
+way. He had ignored or blocked this uniquely human dimension, 
+and this had prevented him from focusing on others (self
+transcendence) and from seeing his automatic reactions from 
+the viewpoint of his authentic self (self-distancing). Jeff 
+gained new insights about himself and his situation. Although the situation had not changed, his attitudes toward it had taken on a meaningful direction. 
+More progress came the next week. Jeff was depressed because of mounting financial pressure. Logotherapeutic intervention made him realize that he had to explore the responses of his psychological dimension (his automatic self) and his spirit (his authentic self). This distinction is important for recovery. The automatic self is influenced by genetic traits, one's past, the environment, biological or physical complications, and the "gut feelings" of emotions. This dimension is concerned more with "what I have" than with "what I am." Responding through the automatic dimensions often results in inner turmoil. 
+Through the logochart, Jeff was able to identify his automatic thoughts that resulted in feeling depressed about paying bills. Those thoughts included. "Why has this happened to me?" "There is nothing I can do." "Why didn't I finish college and have better opportunities for employment?" Jeff was led to examine these questions and statements in light of his authentic self, giving him a glimpse of who he was and still could become. When using this dimension, it was easier for him to make responsible decisions and evaluate them in a way that was personally meaningful. He became more adaptable, demonstrated a greater understanding of the things affecting him, and actually enjoyed the choices that were meaningful. 
+Exploring his thoughts from the authetic self enabled him to test reality. He recognized that the construction boom was over, and not to take it personal. He no longer saw himself as a victim. There were several directions he could still take. In response to the question why he didn't finish college he was able to see that "at the time it was financially essential for me to work. I loved my work and lost interest in school." He wasn't able to change his situation but through testing his automatic thoughts was able to lower the intensity of the depression. 
+He next looked at the meaning he was attaching to his dilemma and the reason why it was bothering him so much. He realized that by holding onto his home and buying expensive clothing he made himself a victim. The mounting pressure from creditors was making him feel less in control of his situation. His authentic self saw that he was choosing to stay in Dallas because he loved the benefits of living in this area. This was the reason he wouldn't consider moving and thus improve his chances of employement. Realizing that it was his choice reduced his frustration of being "undecided." His authentic self decided that due to his commitment to stay in Dallas he must be. flexible in the pursuit of employment there. 
+MANOOCHEHR KHATAMI, M.D., is professor of clinical psychiatry, University of Texas Health Science Center, Dallas; .chairman of the Department of Psychiatry; and medical director, Center of Bio-Behavioral Medicine, St. Paul Medical Center, Dallas, Texas. DENNIS DOKE and RICHARD BOYER are psychiatrists at the St. Paul Medical Center, Dallas, Texas. 
+LOGO CHART 
+Event (Problem): _ _.:,Pe::;.1:::.·n::.ig..::la::::.:i::_d_·_;;:;of~f_c:;.:Jt:...::.wO::.:r...:k~re:.:s:;;.ul:.:t:.:in:.:.g:,_,-=i.:.:.n...:f:.:ee.:.:..l::.;i;:.:n~1.;..::d:.::.c.c.:pr-=e-=sscd.:.:.'~·_______ 
+Jeff 
+SELF .. AUTOMATIC SELF .;. AUTHENTIC SELF 
+AUTOMATIC SELF AUTHENTIC SELF 
+ATTITUDE: Whal do I think about the situation? How do I perceive it? Disloned I sh::luld have playL><l the "politicad Realisllc 
+This is a ":;hould" staterrent, 
+Irrational garre" at: ..ori< to kL.oep the Unrea!isllc: 
+Rigid Learned 
+PUT' 
+Untrue 
+'l1'e political gaire requires staying
+Thoughla 
+at i.ori< for 12 hours. Aud this I.OUld rrean neglecting my fami1y. 
+Rational canin3 fran oucside. My role Adaptable as a husrond and father is rmre Reasonabl& i1;1.pt:1rtunl U1.:m work roll1S. "' Valid cho.,ce Lhis prfority of fomi ly True -;:~ ov~r businessran; it was not Chosen forced oo rrc. 
+MEANING: Whal are the 11alue11, purposes, goals In this sllu11llon? 
+Power 
+Pleasure Conflict of values. Fame. Material 
+Control• .Attempting to control 
+things 
+ti.o canpeting darunds for tirre, 
+Unethical Selfishnesa 
+Love Pr:iJrary puri:o,ses in Life: Creativity -Be a living husband and as Purpose good father to my children as Ethical values i:;ossible Spiritual values -Earn a rn:xlest living Openm1ndedness Selftranscendence 
+BEHAVIOR/RESPONSE: Whal do I do about this situation? (Actions, physical responses/ consequences). 
+Habitual 
+Active
+Frustratioo 
+Lock for enployrrent that
+Dependent 
+Unique• new
+Self -doubt 
+will not significantly
+Lazy 
+Independent
+Anger to..ard "unfair" 
+conflict with my desires
+Rigid 
+Positive
+expectaticns. 
+to spend tine with my
+Almleaa 
+Flexible 
+family.
+Impulsive 
+Goal-
+Passivity
+Passive 
+directed Delayed gratification Reaponaible 
+. 35 65
+Automahc ___% AuthenUc ___% 
+86 
+LOGO CHART 
+Event (Problem): t-bunting financial pressure and needing to pay bills. Resulted in feeling dcui and blue. Jeff 
+SELF • AUTOMATIC SELF + AUTHENTIC SELF AUTOMATIC SELF AUTHENTIC SELF ATTITUDE: Whal do I think 11boul the situation? How do I perceive II? 
+Distorted l..hy had th.is happened to rrc?  Realistic  I have to accept the reality that  
+lrra111.1nal  Rational  the constructioo txx:m is over.  
+Unreaiistu:  Adaptable Don't take it persooal.  
+R1g1d  There is riothing I r~'.ln do.  Reasonable  
+Laamed  why didn't I finish college'!  \lahd  I need to test reality.  Things in  
+Untrue  True  business happen and this is the  
+Thought& With a degree I could have rrore  Chosen  lol8Y reality changes,  
+opportunity to be employed.  I'm vict:imizing • I'm not really a vict1m.  
+There-are severnl directions I can take.  
+I did not finish college because at the ti..roc  
+it was financially ess:nt:ial for ire to w0rk.  
+It just so happened that I loved the .ork &  
+1,-,r:::;::  ,r,t-nrpc,:r"  'in ,...,..h---.... j  
+
+MEANING: What are th• valuee, purpooea, goals In thla situation? 
+Power Pleasure u:introl ·· I .like to be in charge of Fame~ my life, anJ every variables. Mat1.mal 
+things Unath,cal S9ihshness 
+Love I had no way of predicting the Creativityecoocmy ..ould turn so tad, affecting Purpose construction. Ethical values Love for the benefits of livin1 Sp11iluaJ vaiues here in this area -I love Oponmmdoonessliving here so ITlJCh that I Selflranacendenca \,()uldn' t consider llllvilig to 
+improve my chances of 
+eTip1oym:cnt • 
+My cr.ildren ·like the schools here and have rude friends. I 'w0llt to find a job here so 
+thev don't have to rrove. 
+BEHAVIOR/RESPONSE: Whal do I do about this s,1ualion7 (Actions, physical responses/consequences). 
+Habitual 
+Dependent Lazy Rigid Aimless Impulsive Passive 
+Frustration Indecisi\leness 
+Active Unique• new Independent Positive Flexible Goal• 
+directed Delayed graulication f\eapons1ble 
+fused on my decis100 to stay in Callas, I 1JUSt be flexible in the pursuit of employrent. 
+I flllSt lock for a job, but 
+first I need to update my 
+resure. 
+
+Automatic _L% Authunuc~% 
+87 
+LOGO CHART 
+Event (Problem): Guilt aoout not providing fir.c1ncially c1s \.Cll as I used to for my children. Resul tcd in feel; oc d"'prec,c,'fl and sitting R 1,3tching T. V. 
+SELF • AUTOMATIC SELF + AUTHENTIC SELF AUTOMATIC SELF AUTHENTIC SELF ATTITUDE: What do I think about the situation? How do I perC8MI it? 
+01s1oned My children will nor. be able to lrrat,onal dress as i..ell as they like.. Unreahsuc Rigid 
+Learned \,hat if I lose my !'Duse through Untrue forcclo.sure? 
+Thoughts 
+Jeff 
+Realtsflc They rmy not have $::0 designer Ra11onal jeans, but they do have clean, Adaptable adequate clothing. 
+Reasonable Valid Lb I want my children to learn True the aer:erialistic philosophy of 
+Chosen nlife consists of t.nir:.\::'.s?'' I'm c.at,~crophi.zirg -Tue truth is, the house is too ex't:ruvagant for our needs. It's te';,n a const.-:1nt strur.gle to rrake P.:,Y'" rn,::,m:.s, yc,c ;i\i,:e, i.n fe.:ir cf losing it at any tiu:e. 
+MEANING: What are Iha valuea, purpoaes, goal• In this sltuauon? 
+Power Pleasure 
+Material focus: 
+Fama 
+Life• having a nice house 
+Materf~ 
+Life • haV':!.118 stylish clothing 
+things Unethical Saltishness 
+Love Creativity Live by V'dlues/ethic.s r dean Purpose :niportai,t versus living by the 
+Elhical values vglues of others. Sp;ritual ~e1ues Opanmincectness Selrtrunscondanc11 
+BEHAVIOR/RESPONSE: Whal do I do about this s1tua11on? (Actions, physical responses Iconsequences). 
+Habitual 
+Anxiety 
+Dependent 
+Guilt 
+Lazy 
+Passivity 
+R1g1d 
+Sit and watch T.V. 
+Aimless lmpulal11e Pasai11e 
+
+Automatic~% 
+Active 
+Sel.1 the hoose. 
+Umque • new 
+lndependsnl 
+l.oc,k for ha.ising without 
+Pos1u11e 
+being status o:nscious. 
+Flexible Goal-directed 
+Delayed 
+gralification Responsible 
+Authentic ___?2._% 
+88 
+Overcoming the "Tragic Triad" Elisabeth Lukas 
+At a logotherapy conference a participant handed me a 
+Chinese saying: "We cannot do anything about the fact that the birds of worry and distress fly over our heads -we can, however, prevent them from building nests in our hearts." This saying is in keeping with logotherapeutic ideas, especially when it comes to the "tragic triad -suffering, guilt and death which are part of the unalterable reality of our existence. 
+Saying that the birds of worry and distress must not build nests in our hearts means that, although the "tragic triad" represents a reality of our life we can, applying the power of our human spirit, overcome the emotional distress which follows in the wake of suffering, guilt, and death. 
+Suffering 
+All suffering represents a loss. For example, a man suffering from serious illness has lost good health. A woman suffering because she cannot find a partner, has lost hope for a fulfilling love relationship. A loss need not be irrevocable. A temporary loss of self-esteem, brought about by a long period of un-employment, can also result in acute emotional distress. 
+Logotherapy focuses less on the origin of suffering, and more on how to bear it. Frankl points out a direct connection between our ability to suffer and our basic attitude toward life. In the Logotest (which records attitudes toward life and investigates goals one has set oneself, whether one has reached them, and how to assess one's successes or failures) a young man wrote: "I have reached almost all the goals I have set tor myself, both privately and in school. School was a means to an end -to attain a position in life where I feel good. Life itself seems meaningless, but I am here whether I like it or not, so I want to make my time here as pleasant as possible. If anything were to upset my plans, I would regard it as a terrible blow." 
+These few sentences express his belief that life itself is meaningless, therefore it is to be made as pleasant as possible; if this fails, the consequences would be terrible! This results in a disastrous, though perfectly logical, chain of three links: 
+1) If life has no meaning, we transfer our attention to direct pursuit of pleasure. 
+2) Pleasure, however, cannot be directly attained, but is the by-product of a meaningful activity or encounter; therefore we probably will not succeed in finding it. 
+3) If this is the case, a life without meaning and now 
+also devoid of pleasure, becomes practically unbearable. By joining the third link with the first, we realize that 
+our ability to bear suffering depends on the strength of our inner feeling of meaning fulfillment. It we regard our life as basically meaningful, we can put up with great suffering because life does not lose its meaning even if our pleasure has been diminished. 
+People, with a good sense of inner meaning fulfillment, are intuitively conscious of meaning. They sense it, take their bearings from it, and have something to search for. In peak moments they glimpse it, but it remains elusive. 
+People with a poor sense of inner meaning fulfillment do not even know what they are searching for and usually fail to find anything. Not having anything to search for is painful enough -but when, in addition, they experience a blow of fate. their capacity to carry burdens breaks down completely. When we have lost our security because we doubt the meaningfulness of life, blows of fate are felt as dramatic voids in our existence. 
+Countless examples have shown that meaning can be perceived and fulfilled in spite of suffering, or even because of it. I remember a mother, Mrs. A., who told me the story of her adopted daughter. 
+After years of childless marriage she became pregnant. The child, however, was born dead. Mrs. A. lay in the hospital, weeping. In the next bed lay another woman, also weeping although her newly-born baby was perfectly healthy. She was a guestworker who had come to Germany to earn money. She became pregnant as a result of impulsive behavior and now could not return with an illegitimate child. There the two women lay during those difficult hours, shattered to the very core of their being, yet united by fate. Suddenly their individual suffering took on a common meaning: the guestworker gathered her courage and passed her baby on to Mrs. A. who accepted this little stranger with a heavy heart. This resulted in the adoption. When I saw the girl six years later, I saw a child who beamed at me through dark cheerful eyes, clearly happy and loved. 
+It looks like a "happy ending" but it came at considerable cost. The adopted girl was not a "substitute" for the stillborn baby, nor was parting with the little girl an ideal solution to the guestworker's problems. Nevertheless there had been meaning in the way both women acted, a meaning born out of the pain they were forced to suffer -a meaning which ultimately helped both to overcome their pain. 
+Another client lived in the country and suffered from a severe physical handicap which excluded him from many of the good things in life. He said to me: "You know, Dr. Lukas, even trees in dense forests that receive little light and warmth, and are thin and deformed, have their value. They provide wood for heating and offer us warmth and comfort in our homes. I can do the same, and that's a!I I want: provide warmth even though fate has given me precious little of it." Indeed, this man is held in high regard in his village because of his heart-warming manner. 
+These are immense achievements of the human spirit, examples of how loss can be overcome, born out of the knowledge that everything contains meaning which can be extracted even when facing utmost despair. I am not talking about putting up witt1 suffering, repressing 1t, rationalizing or overcompensating for it. I am talking about an inner self-distancing that enables us to recognize meaningful structures that help us transcend the situation. If we stand upright m the face of suffering we remain above suffering and become a "towering" example for others. We radiate a strength that spreads in the world around us and help others by our example; we invite others to imitate us. 
+There is. however, a kind of suffering that is self-made and contains no meaning. We all know persons who put themselves into situations of suffering, whether for neurotic self-punishment as a means of manipulating others, or simply out of resignation. Just about every form of addiction can be put into this category of self-inflicted suffering. 
+These persons do not have the probiem of confronting fate or facing a loss; their problem ,s their inability to see and actualize the positive possibilities lite otters them. In these cases, inner meaning fulfillment plays an extended role: it does not enable them to bear suffering passively but also prevents them from actively inflicting suffering. There is a iogical explanation for this. Meaning orientation enhances our ability to endure suffering because even a life darkened by suffering does not lose its meaning. But meaning orientation also inhibits our tendency to inflict suffering because a life not darkened by suffering gains meaning. If we can overcome our self-hate, tame our manipulative impulses, or resist our tendency to become addicted, we have the chance of a richer, more fulfilled life. We can tackle plans that would have been out of the question, and we can open ourselves to experiences that were out of reach. When we are confronted with suffering -our own, or of others -we need to remember that lite darkened by suffering does not lose meaning, but lite not darkened by unnecessary suffering gains meaning. If we bear this in mind, we will find it easier to abandon self-inflicted suffering and pursue optimum psychohygienic attitudes toward the given circumstance. 
+Guilt 
+The complex subject of guilt comes under the heading of overcoming failure~ Here we enter the realm of our personal past, for any current happening is still in the stage of development and cannot be called a failure before it has reached a conclusion. By failure I mean failure for which we are responsible. Failures for which we are not responsible belong in the category of unavoidable suffering. 
+Regarding failures for which we are responsible, the gods are not very merciful: they rarely cover these failures with total oblivion. rather they let a little tip show. which functions as "guilty conscience.'' This does not necessarily mean that there is emotional damage. On the contrary. 1t might even lead to spiritual maturity. In logotherapy, guilt is looked upon as an opportunity to change, as an appeal to abandon old patterns and make new and better decisions. Tt1erapists do not pass judgment but rather pertorm two functions. 
+First, together with the clients, they can explore whether or not the guilt feelings are justified. Together they can ascertain whether the clients are responsible for w~1at has happened or whether their failures can be attributed to factors beyond their control. We know that people often feel responsible for events which overwhelms them althougt1 tt1ey had little or no choice. Such events may justifiably cause anger or sorrow, but they must not be allowed to trigger feelings of failure. Should this be the case, therapeutic measures must be taken to counteract them. 
+The second function of the therapist is to help clients overcome failure when the sense ot guilt is indeed justified. A therapist is not a father confessor who can grant absolution. The so-called "psychological absolution" is too easy a way out: It requires virtually declaring the client incompetent, a helpless victim of powerful unconscious forces or conditioning processes which have formed the client's character. No, there is another way of assisting without taking away the clients' spiritual freedom and dignity.In logophilosophy, we speak of an "optimism of the past," which regards the past as our "being" in its most genuine and concrete form. All things past are unchangeable, nothing can remove them. The future, in contrast, is rich in possibilities but devoid of realities; it holds nothing final, every potentiality is only an opportunity which may or may not be taken. On the borderline between the nothingness of the future and the eternity of the past lies the present. We can never guarantee what will be actualized in the next moment. But what has been actualized a moment ago remains forever. 
+This means, the only sure thing that can really be called our own, the only reality that remains inseparably linked with our lives is what "has been." Take as an example a woman who has spent five years happily married to her partner. No power on earth can take those five years away, for they have been actualized, they have been "brought in as a successful harvest," as Frankl would put it. Whether the woman has 50 more years, or just one more day of happy married life left, is a question which remains unanswered. it is a question caught in a net of countless possibilities, none of which is yet a reality and none of which, with the exception of one, will ever become one. 
+From this "optimism of the past" Frankl derives an "activism of the future.., If eternity simply were to lie ahead of us, ready to unwind aH by itself, we could just fold our arms and wait fatalistically for wt1at lies ahead to happen. But because there is nothing ahearl of us but unborn possibilities for whose selection we are responsible, we face the obligation to spot the most meaningful ideas, actions, and attitudes among the possibilities and to rescue them from the uncertainty of our future into the security of our past 
+Guilt, therefore, can be seen as the result of a wrong choice, having actualized a possibility better left unchosen. But now it has become anchored in our past forever as an irreversible part of our life. 
+Seen this way, guilt is the converse of the "optimism of the past"; it is the "pessimism of the irrevocable." This is where the "activism of the future" comes in. Meaning can be found retroactively in all the good one did as a consequence of guilt, in every success learned born out of failure, every positive opportunity seized because priority once had been given to a negative one. Finding meaning retroactively can be seen as a "correction" of a previous wrong choice regardless of how irrevocable it was, because something meaningful cannot be entirely wrong. 
+Thus, we need not declare our clients incompetent and grant them "psychological absolution": in fact, we must not declare them incompetent if we genuinely wish to help them overcome failure. Only responsible people, who are truly aware of their responsibility to choose among many possiblitities even possibilities that may lead from originally wrong choices to positive results -only those people are in a position to resolve their guilt by revising their attitude toward it. In fact, we may find this insight reflected in the salvation myths of all great world religions. Only the relatively young science of psychology has disregarded it to date. 
+Just how unfortunate this disregard is, is shown by an experiment that has been carried out for many years on juvenile delinquents in my Munich counseling center. Socalled "firsttimers," with the consent of the Juvenile Court, receive early release on condition that they participate in group therapy sessions. We are currently using the third approach for working with these delinquents and it would appear tllat we are now succeeding in keeping the rate of recidivism considerably lower than in previous years. 
+The first approach was based purely on social training. It failed because training assumes that participants bring sufficient motivation on their own to reach the training goaL Our clients did not t1ave such motiv:rttion 
+The second attempt sough! 1:0 provide them wiH1 reasonable problem-solving strategies. Alttlough H1ey brougt1t sufficient problems with ttiem and were fairly motivated to work on solutions with the group leader, the problems discussed -mostly related to family and work -quickly became excuses for their faulty behavior. These excuses eliminated any possibility of finding meaning through subsequent correction of guilt. 
+In our third attempt we applied logotherapeutic principles. We let guilt remain guilt, not as accusation or reproach, but as an opportunity to consider positive abilities. which each young delinquent possessed regardless of environmental circumstances. We demonstrated to the participants that just as they had been free to commit a wrong, so too were they free to do a meaningful deed. Since then a new attitude is gradually working its way through the mockery, scorn, disinterest and demoralization. Occasionally a participant uses his or her freedom to do a meaningful deed. This encourages the others, and gradually the change in attitude leads to a change in behavior. Granted, the path is rocky, and there are setbacks, but this path clearly leads to overcoming failure. 
+Death 
+Logotherapy has given much attention to death, Here the issue is overcoming transitoriness. We are dealing with the question of how to handle our knowledge that we are mortal. No other living creature is required to carry this burden. 
+Logotherapy once again relies on its "optimism of the past" and points out that nothing can take away the valuable things we have done and which are irretrievably anchored in our past. Every task we have fulfilled, every happy experience, every suffering courageously borne, every guilt redeemed in a mature manner -all these things have become part of the eternity of the past. the essence of our being, the quality of our life, our identity. None of this can be taken away from us, even long after we have returned to dust. 
+When we discuss such ideas with clients, they often question whether the events of their lifetime have not become irrelevant by the time nobody knows anything about them any longer. "Wt-lat difference does it make", they ask, "whether I have lived a good life or whether I suffered courageously when nobody remembers me after my death?" Yes, everything is forgotten; nothing earthly can be remembered forever. But what is past still remains as it was; its "no longer being known" cannot wipe it out Frankl wrote: "Thinking of something cannot make it happen; by the same token, no longer thinking of somet11ing cannot destroy it." It remains. Whether the level of !Is quality makes difference, is a question that we can only answer tt1rough faith. But our cjeep longing for salvation and our existentially rooted search for meaning indicates that what has remained of each of us in our past does matter. 
+A Case History 
+i would like to conclude these philosophical considerations wiU1 a case history that illustrates the "tragic triad." A marrie1j couple sougtlt my advice in a rather delicate matter. Mrs D, who wore mourning, told me ti,at a few days ago her old mother had died after a long sickness. The problem was not the loss of the mother, which had been expected, but whether the father of Mrs D should be told of his wife's death. When I asked how it was possible that he did not know about it, I received the tallowing explanation: 
+The parents had been married for many decades and had truly loved each other. When Mrs. D's mother became sick, the father took care of her and refused any help from others. Taking care of his wife became the content of his life, his personal task. But three weeks earlier he suffered a heart attack and had to be hospitalized. At present he remained in critical condition in intensive care. It was not certain how much he knew about what was going on, as he was mostly unconscious, but occasionally he seemed to indicate that he was bothered by something. Also he often played with his wedding ring. Mrs. D suspected that he was worried about being sick when his wife needed him. 
+The doctors advised not to tell the critically ill man the bad news because they feared the shock would kill him, and they wished to spare the dying man that last pain. 
+The arguments of the physicians were plausible but let's consider the old man's situation from the point of view of the "tragic triad" and how he might overcome it. His future held little hope. He was bound to die of heart failure, and if a brief respite should be granted to him, he would return to an empty apartment and mourn his wife. In contrast, the realities of his past were that he had lived a full life, faithfully worked in his job, fought through the bad years, enjoyed the good ones, and devoted his last years to his wife. He had actualized a rich human existence on which he could look back w,tr: satisfaction and pride Only one bitter pill was left, one task had not been completed: the care of his wife, in his eyes, was not finished. Here he may feel failure --the worry about Hie beloved partner may rob the dying man of inner peacEi, and not !et him ti1e peacefully. Mrs. D sensed it, she knew her faHier weil enough to guess what was happenin{J in his mind. 
+I advised her, contrary to Uie recommendations of the physicians, to let the father gen11y know that 1·1is wife had preceded him and that he needed not worry about having left her behind. This, we hoped, would r1elp the old man see that he had also fulfilled his last talk, and he would t:,e able to close his eyes in peace. 
+I must admit that I felt doubts when I let the couple go from the counseling session. We can never be entirely sure if the meaning we have read into a situation objectively was "meant" by the situation or if we subjectively have decided to consitjer it meaningful. 
+In this case I received positive feedback. Mr. D let me know that his father-in-law had received tr1e news of his wife's death calmly. He had nodded his head several times and whispered: "That's good, now l'I! join her." He then lived longer than the physicians expected. He slept most of the time with a relaxed expression on his face. Wtlen he died, the fingers of his right hand clasped his wedding ring. 
+ELISABETH LUKAS, Ph.D. is director of the South German Institute of Logotherapy in FOrstenfeldbruck near Munich, Germany. 
+A  Journey  Who Am I? of Self-Discovery  
+Phyllis  P. Ward  
+During  eight  years  at  the  Shealy  Institute  for  
+
+Comprehensive Health Care in Springfield, Missouri, I worked with patients experiencing chronic pain and stress disorders. I taught biogenics(R) to groups of patients -a system of relaxation techniques for voluntary self-regulation. These techniques help individuals achieve psycho-physiological balance and such health benefits as voluntary control over autonomic functions, reduction of insulin requirement, and production of adrenalin or cortisone Developed by Shealy, 2 biogenics@ combines techniques such as biofeedback, autogenic training, and mental exercises from Emil Coue, Edmond Jacobson, Gestalt, and psychosynthesis. The exercises also result in physiological balancing, psychological insights, spiritual awarenes, emotional balancing, and goal-oriented programming. 
+One exercise, based on the work of Assagioli 1 and adapted by Shealy, is called "self-identification exercise." 2-PP-226-231 It helps people find answers to the question Viktor Frankl finds prevalent today: "Who am I?" 
+Applications to Patients 
+Tt1e self-identification exercise leads patients to stop identifying themselves with such aspects as body, mind, emotions, desires, roles, and activites. Phrases such as "I have a body but I am not my body" helps them achieve self-distancing, the first step in logotherapy: My body may find itself in different conditions of health or sickness. it may be rested or tired, but that has nothing to do with my real self. 2-P 226 
+After the exercise patients are more aware of their true identity -their center of self-awareness -from which they can learn to observe, direct, and harmonize all physiological processes. This concept agrees with the logotherapeutic view. 
+When coming to the Institute for the two-week intensive program, patients tend to focus on physical malfunctions and the consequences in their life situations -loss of job, recognition, good health, financial security, personal relationships, specific roles. The self-identification exercise is introduced near the end of the program when patients have learned to dereflect from physical pain and discomfort, and see themselves as more than just a malfunctioning body. They are able to focus on their spirit as source of strength, no matter what changes are going on in the outer manifestations of their lives 
+I expanded the exercise by incorporating some of the concepts ot logotherapy. It has now become a meaning-oriented exercise titled "Who Am !? A Journal of Self-Discovery" 3 
+The exercise differs from Shealy and Assagioli. I draw a wheel on the board (see Figure 1) with the hub representing the noos (what we are) and nine spokes representing areas which we have. but can choose to take a stand against, such as possessions, emotions. desires, etc. We can identify or refuse to identity witt1 the spokes, but the hub is our noetic-spiritual dimension. our healthy core, the source of our will to meaning, our potentials, our capacity to self-transcend. It is the source of our courage to take a stand, religious faith, compassion, conscience, and sense of humor. I tell the participants to . . . allow yourself to come to the Center . . the spiritual source of your being, the potential of who you are to become, the I AM, the beingness of fluman being, beyond human doing and human having. At the center resides the capacity to choose beyond the instinctual, to love beyond the sexual, to imagine and create, to think abstractly ...3,P4 
+It is at this center that we are connected with other humans and with the higher power of our undertanding. Near the end ot the exercise ! invite the participants ...to gradually allow yourself to open the gates, remove the barriers, take down the walls between your center and the outer aspects -the spokes of the wheel of your life. Allow the essence of your being, the center of meaning, love, compassion, humor, ideas and i(Jeals, conscience to flow 
+throughout your  lmaqine seeing and feeling this  
+essence  tfim1  bo(ty  now.  balancing anci  
+changing what can t,e  loving. forgiving, am:f  
+
+above what cannot be changec1 3 P 4 Ttie participants are guided to open the gates to eact, of Hie spokes, allowing Hrn noos to flow through eactl. For instance: 
+Think ot your possessions, the things you choose to keep, the things you choose to let go, and then contemplate these thoughts: "I have possessions, but I am not my possessions. They are outer expressions of my tastes, interests, values, and of those who share my living space, but they are not me. The true me, the '/.·is separate from my possessions." 3, p. 3 
+Applications to Self 
+Wtlat does it all this mean to me, a student of logottlerapy, teacher, stress management consultant, and human 
+being? This journey of self-discovery brings me around full circle, yet three-dimensionally onto a higher plane. I no longer work at the Shealy Institute, and since January 1989 have been on a roller coaster ride, traveling at various speeds, asking myself the very question: "Who am I?" No longer being someone's spouse (my husband died in August 1988) and no longer being a counselor/teacher at the Institute, I was temporarily lost for clear answers to the common questions of social niceties, "Where do you work?" "What do you do?" "How are you?" These two major losses plus changes of residence and sorting of belongings brought about changes in eight of the nine spokes of my life's wheel -with the potential of a flat tire. Roles, activities, sources of recognition and friendships, financial security, mental activity, possessions, desires, emotions all changed. Only body and heredity remained constant, and even the body experienced the consequences of the stress. 
+In my own journey I have experienced the need to ... dig deeply into the well of the healthy core, the source of [my] being for strength, dignity, courage, humor, compassion, love, and hope to live a meaningful life. 3-P5 
+I am discovering who I really am, as a spiritual being. am also discovering that I have much more available than I ever realized, and that I can withstand many more changes and blows of fate than I thought I could. I would not have had these insights, had it not been for the losses I encountered. My temporary times of despair and doubt were brought back into perspective as I experienced the loss of a former colleague through suicide and of two friends my age through long and courageous struggles with cancer. As logotherapist I know that my attitudinal values were being tested. From the bitter comes forth the sweet; from adversity, strength; from the challenge of self-identification a better appreciation of the search and of the seeker, with the accompanying doubts, fears, pain, joy, excitement, and anxiety. 
+I have glimpsed ultimate meaning and experienced the meaning of the moment. I glimpse ultimate meaning as a freedom, a strengthening of my religious faith and a "knowingness" that there is Order in my life even though it appears to be chaos. I experience the meanings of the moment as the responsibleness to how, where, and under what circumstances I choose to use my time, talents, strengths, and knowledge. I am becoming more aware of my values and how I choose to actualize them in my life so that each of my spokes more clearly represents, reflects, and allows the essence of my being to flow through them, flooding them with meaning. My wheel is becoming round again, no flats, moving at various speeds. The things l do, the people I love, and the causes I serve have all taken on new meanings. 
+We don't need to experience pain, stress disorders, or major life changes to experience this journey of self-discovery. We all can take time to become acquainted with the spokes and the hub, the areas we have and the healthy core we are. 
+PHYLLIS P. WARD, M. Ed. is a teacher and therapist in Springfield, Missouri, previously applying logotherapy at a clinic for people with chronic pain and stress disorders, currently with private clients and students. 
+REFERENCES 
+I. Assagioli, Robert, The .Act of Wifi. NY, Penguin Books, 1974. 
+2. 
+Shealy Norman, Biogenics@ Health Maintenance, La Cross, Wisconsin, Self-Health Systems, 1980. 
+
+3. 
+Ward, Phyllis P. "Who Am I? A Journey of Self-Discovery," Springfield. Missouri, Pelican Tapes, 1990.(A 60-minute cassette tape is available from Pelican Tapes, 3731 S. Glenstone #90, Springfield, MO 65804, $9.95 plus 60¢ for handling and postage. One side contains the "Who am I" exercise, the other a relaxation exercise.) 
+
+
+Figure 1. The Wheel of Noos 
+
+A Case History in Existential Analysis Psychotherapy 
+Alfried L~ngle 
+In the Spring 1990 issue of the Forum A/fried Langle discussed the principles of Existential Analysis Psychotherapy which he developed for cases of which Viktor Frankl wrote in the foreword of his Theory and Therapy of Neuroses (1956): "There really are no purely somatogenic, psychogenic, and noogenic neuroses, but only mixed cases . . . in which a somatogenic, psychogenic, or noogenic element has moved into the foreground of theory and therapy.'·' Langle developed Existential Analysis Psychotherapy for psychogenic disturbances and noogenic neuroses that require attention to the psyche.Existential analysis psychotherapy deals with problems of meaning but is also concerned with questions of justification of one's existence .and the personal "will to being." 
+The patient was a 30-year-old married clerk. He had been in individual therapy with a diagnosis of somatization disorder and a depressive personality. In recent months a violent rage continued to surface during therapy, without clear reason. He felt life was a burden, he felt insecure, listless, unfree. Since childhood he suffered from a lack of security, his many anxieties were accompanied by somatic disturbances. Early childhood blows and the feeling of having been rejected by his mother (and, after he was eight, also by his stepfather) led to what he called a hatred for people and to a general withdrawal. The world seemed hostile. He experienced the withdrawal as an "obstacle to living" because it was involuntary and enhanced his frustrated desire to find contact with others. "All my life I've felt miserable, forsaken, outlawed, humiliated." 
+Opening Phase of the Therapy 
+The patient reported morning fatigue, even after a good sleep. After excluding endogenous depression, the dialogue focused on Frankl's existential vacuum. Therapist: Have you ever asked yourself why you get up in the morning? Patient: Because I want to live, experience. Therapist: Experience what? 
+Patient: I don't know. (After a pause): Joy! I want to experience joy. 
+(He wasn't able to be more specific. He just let himself live day-by-day, he said, and experienced himself as an observer of his life. His main goal would be to step off the spectator stand and enter the playing field. During the discussion of what he would have to do to enjoy himself he suddenly burst out: "You know ... I really have no right to stand on my own feet. I have too much fear of the adult, a deep, terrible fear.") Therapist: Fear of becoming an adult yourself? Patient: I'm not an adult. That's a world in which I am not allowed to participate. I can't do it. i don't want to. Therapist: Can you give an example what you mean by "the adult world?" Patient: That's a world where people have rights, possibilities to shape their lives, freedom to act. A world of decision-making. I have no access to it. ! am excluded. I see a picture in my mind: my family sits around a table, and I stand nearby and am excluded. Therapist: Perhaps you can close your eyes and !ook closer at the picture. Patient: (leans back comfortably, closes eyes): They have fun, understand each other, I am the one who is excluded, without rights. I'm not allowed to participate. Theirs is a world of joy. My world is one of oppression, rules, punishment, suffering... My presence is tolerated. That's the typical mood. Even today. My most precious experiences came from outside the family, from friends ... The family is a mere feeding trough, a place of authoritarianism which I have to accept. Therapist: Who's sitting at that table? Patient: Stepfather, Mother, uncle, his wife. Therapist: What do you feel? Patient: Envy that I can't be one of them, that they don't pay attention to me And caution. Resistance. Having no rights. I used to think it was inferiority. They all exclude me. Therapist: How do they do this, excluding you? Patient: They ignore my presence. They give orders, I have to obey. Therapist: Is there anything new you feel when you imagine your family this way? Patient: Yes. Therapist: What do you feel? How could you express it? Patient: There is a rock on my chest. (Breathes deeply.) 
+Therapist: What could you do with the rock? Patient: I could roll it under the table. Then it wouldn't crush me. This rock symbolizes my hate. If I would roll it on top of them it would crush them. Therapist (after a pause): What's the matter? Patient: I feel sick, my stomach hurts. That's how I experience the world. I am the one who has to obey and cannot participate in the adult world. Therapist: Is your hate connected with the people at the table? Patient: Yes, it's connected. They are at least part of the cause, perhaps the main cause. (During the following the client remained in a reclining position, his eyes closed.) Therapist: Could you say something to those people about how you feel? Patient: I don't know if they would understand. And I'd be afraid ...it could lead to uncomfortable discussions. Therapist How would you formulate your feelings? Patient: That's difficult, really difficult. I would have to think about it for a long time. It's almost hopeless. Therapist: Just formulate it for yourself. You don't have to voice it to them. Patient: In my mind I see myself shouting: It's all your fault! Therapist What? Patient: That I am miserable. Therapist: How did they do it? Patient: By disregarding me. By paying no attention to my needs and wishes. (Pause.) Therapist: Could you formulate it so you address them directly? Patient: It's your fault, you are responsible that I feel miserable, you disregard me, you pay no attention to my wishes, you don't understand me! (Exhales deeply.) Therapist: How do you feel now? Patient: Much better. The weight has lifted. Therapist: What reply would you like to get? Patient {answering immediately): If they would ask me to discuss things with them. On a level of understanding. Therapist: How would that work? Who would have to say what? Patient: If Mother or my stepfather would ask me to sit with them at the table. If I could state my problems and if they would discuss them. Therapist: What problems would you bring up? 
+Patient: For example, the problem of punishment. That it is harsh and excessive. And that the punishment separates me from the world of the parents. Therapist: What answer would satisfy you? Patient: That I see they understand, really understand, what I am saying. Therapist: What would they have to say or do? Patient: I can't say, it's impossible. Therapist: How would you want your parents to react so it becomes possible? Patient: They would have to react with empathy. Therapist: What does that mean? Patient: With understanding. Therapist: What would your parents have to say? Patient: Give me hope, in some form or other. Therapist: How? Patient: By showing more interest in me, in some way. Therapist: What would you like to happen? Patient: To be loved. Therapist: What would your parents have to do so you can experience love? Patient (after a pause): That they don't distance themselves from me. But this probably goes back much farther, to the time when I was alone with Mother. That played an important part, I'm sure. Therapist: How old were you then? Patient: Rather small, three perhaps. It went on until I was five or six. Therapist: What would your mother have to do so you feel loved? Patient (after a pause): I couldn't say. Therapist: Did you experience that you were loved? Patient: I realize that I was very attached to Mother when I was a child. She was everything, my whole world. And at the same time I was alone. Therapist: Mmm. Patient (after a pause): I see clearly that it's not so important how long we're together, but the quality of the affection, under-standing, interest. (Pause, the client slowly opens his eyes.) Therapist: If you could tell Mother about your pain and suffering in your own words, how would you express it? Patient: That I have gone through hell, and that I ... Therapist: Could you address your mother directly? Patient (groans): It's so difficult addressing her directly. 
+Therapist: "Mother -• Patient: Exactly. The "I-Thou" relationship is missing. (A long, reflective, sad pause of about four minutes followed. His vegetative system became audible through stomach growling, followed by a deep sigh. The relationship with his mother had been found but the "I-Thou" relation came only in sessions much later.) Therapist: What was the hell you went through? Patient: Being alone in the world. Being alone and being without rights. (Tears well up in his eyes.) Therapist (after a pause): At what age? Patient: Before I was ten. The whole time I was alone with Mother. But being without rights was worse than being alone. Therapist: What do you mean by 'being without rights'? Patient: I had to conform to the wishes and customs of my parents. Therapist: Why was this so painful? Patient: Because I didn't want to it. Therapist: What did you want? Patient (after a pause): I don't know. (This became the topic of future sessions.) Therapist: Why didn't you want it? Patient: Because it meant coercion. Coercion to obey. Therapist: Which means they won't let you be? Patient: Right. Yes. (Pause): I'm glad this is coming out now. I think we really have come closer to my true problems. I feel sick ...in my stomach ...miserable ... like throwing up. (After a while): It's getting better, slowly. Therapist: I'll stay with you a while. Until you feel better. Patient: Mmm. That's nice. (Lowers his eyes; again strong stomach growling during a pause of about three minutes.) Therapist (showing empathy): I detect a great deal of sadness and confusion. It makes me sad that this was the way it was.You were close to tears. Patient: Yea, I also felt tears a while ago. Therapist: But you didn't let yourself cry, really. Patient: Mmm, yes. That's true. (Pause.) 
+Therapist: I think you will go home now with your sadness and bear it. You think you can bear it? Patient: Oh yes, I'm sure. (While leaving): Things have become clearer. Today J was realty sad for the first time. A while ago I couldn't ima_gme I could be sad about anything. 
+Final Comments 
+The method of dialogue presented here certainly needs further and more precise refinement. Those familiar with existential analysis will have recognized the essential elements at which the questions were aimed. These specifically include Frankl's deep reflections about the person and his or her characteristics, as well as about human existence and its basic conditions as outlined in my article in the Spring issue of The International Forum for Logotherapy. It stated that he therapist has to 
+• 
+be "with"' the patient on a noetic level 
+
+• 
+understand the patients' motivations (will to meaning) 
+
+• 
+help patients relate to themselves and their world, especially through modification of attitudes. 
+
+
+In future sessions the client experienced for the first time in his life a liberation from the symptoms he described, although his feelings of being without rights turned up from time to time. The dialogues about these feelings showed that he had never seen his mother as an individual, as a unique person who could not be replaced by anyone else. His interest in her increased and resulted in long talks with her in which he found an I-Thou relationship. Eventually he discovered that he himself had distanced himself from others, and that he had withdrawn into his "inner castle" at the time when he could not relate to his mother. Locked into this inner castle he experienced himself as victim of circumstances and made him grow into a rebellious youth and adult. Now he was in possession of a key to take charge and change his defiant mood of distancing himself from others. He no longer felt 'excluded from life,' and 'distant from the world.' He had found a way to 'lift his life into the real world.' 
+ALFRIED LANGLE, M.D., Ph.D., is director of the Society for Logotherapy and Existential Analysis, Vienna. Austria. 
+Relevance of Meaning for the Developmentally Handicapped 
+Dave Hingsburger 
+Logotherapy's main criticism of many counseling theories is their reductionistic approach.1 In reducing human behavior to stimulus responses or to drives, therapists limit their understanding of the client's life5 and transfer the power to define the client's experiences from client to therapist.a With such theories the therapist's aim is to change the clients' behavior or understanding of their behavior. The clients' power to define their experiences is often lost in psychological jargon and clinical interpretations.6 The therapist's ability to 
+understand can be restricted when trying to fit information from the client to preconceived notions. 
+This may especially happen with the developmentally handicapped (mentally retarded). Because of language deficits, external interpretations of client behaviors are common. The most common treatment for such individuals is behavior therapy,7 with its structured framework that defines behavior as that which can be seen, counted, and measured. However, this reduces whole interactions to single behaviors whith the risk that the issue is the behavior, not the person who performed it. 
+The role of self-definition and meaning has no place in many therapies. Both are too often absent from therapy with the developmentally handicapped. Such individuals frequently are viewed as unable to participate in therapies requiring insight.a Thus, their lives are often completely defined by others. 
+The following three examples indicate that those with developmental handicaps can have capacity for experiencing, understanding, and defining meaning. The realization that they can experience meaning opens 10 a whole new avenue for working with this population; it opens the field of the developmental handicapped to logotherapists. 
+Case 1: Barb 
+Barb was referred for severe self-stimulating behavior. She lived at home and would secrete herself in her room, turn on music, and begin a rapid back-and-forth rocking. She would not stop on command but kept rocking until exhausted and sweating. Because of her heart condition the rocking could be fatal. 
+The behavior clearly met criteria to be defined as selfstimulation, common among individuals with a developmental handicap. But unlike most who engage in this behavior, Barb was extremely high functioning. She rocked daily, usually in the evenings, sometimes first thing in the morning. The late morning was busy with getting ready for her work at a local library stacking shelves and placing slips in book jackets. 
+When the therapist asked her about the rocking, she did not acknowledge any awareness of self-stimulation. She did acknowledge going to her room early in the evenings and listening to music. When that line of questioning proved fruitless, the therapist asked about her job. She stated that she liked her job, but there was a distinct lack of enthusiasm. When asked it she would like to continue working in the library for a long time, she said no. What then would she like to do? She stated shyly that she couldn't do what she wanted to do because of her heart. Eventually she said that she would like to be a dancer. 
+Dancing was the last thing the therapist expected to hear because developmentally handicapped persons seldom have artistic goals. At this point the discussion returned to the selfstimulating behavior. She was asked if the rocking was her way of dancing. She said she danced, and she "danced angry." It became clear that the rocking was not self-stimulating but rather an angry response to physical problems with her heart, which she blamed for not being able to pursue her goal. In meetings with her parents, social worker, and physician, it was decided that Tai Chi (a form of Chinese body movement exercise) would be safe for Barb. She was offered the opportunity to attend classes with a volunteer, and quickly accepted. The rocking behavior decreased and eventually stopped. 
+This treatment stands in stark contrast to the kinds of behavioral procedures which have been recommended for some kinds of self-stimulation. While the cases in the literature present effective use of behavioral programming to reduce inappropriate behaviors, clinicians looking to solve difficulties should be led whenever possible by the client's noetic dimension; and then assisted by the literature, not the reverse. 
+Case 2: Mark 
+Mark was referred for what was externally interpreted as sexually assaulting women clients at a sheltered workshop. He grabbed them around the waist and touched their breasts. This occurred frequently, although it was impossible to count exactly how often bcause he engaged in this behavior primarily when the staff was out of the room. The sexual assault was of great concern because Mark could be criminally charged and it was feared there was the possibility of rape. The staff had attempted to curb the behavior by not leaving him alone in the work area. This reduced the behavior, but it was realized that he needed to work on self-control. 
+The therapist met with Mark and discussed the behavior. When Mark was asked what he was doing in the workroom with the women, he smiled and said, "Mark tickles the girls." This took the therapist by surprise as "tickle" is as nice a word as "assault" is not. On the assumption that Mark had probably been tickled in the past, the therapist asked if anyone ever tickled him. Mark was quick to reply, "Wendy." 
+The therapist tried to find out about Wendy and the nature of their relationship. Was Wendy his sister or a relative? No. Was she a friend of the family? No. Someone from the workshop? No. Mark refused to identify her. In later discussions Mark told of living in a large institution for the developmentally handicapped. When asked what he liked about living there, he said, "That's where I met Wendy." This answer was a surprise because the facility was for males. It turned out that Mark had met Wendy at one of the dances where the female and male institutions participated together. Mark had looked forward to the dances and would dance with Wendy every time, and they would tickle each other. When the two institutions were closed, Mark and Wendy lost touch with each other. Mark was trying to form another relationship like that with Wendy, and he was using his favorite part of their relationship as a means of attempting to establish a new relationship. 
+Clearly, Mark needed to learn how to approach women for friendship without assaulting them. Yet, this approach alone seemed shallow. Mark was asked if he would like the therapist and staff to look for Wendy. He said that he would like this. He agreed to help with the search and sat in on all phone calls and assisted with letter writing. It took several months but Wendy and Mark were finally reunited. They lived only an hour apart from each other and could visit each other. The assaults on other women stopped -not after Wendy was found but as soon as the search for her began. No other programming was necessary. 
+Punishment has been used with the develop-mentally handicapped to reduce aggression. But without the addition of logotherapeutic principles, any form of psychotherapeutic approach (be it behaviorism or psychoanalysis) runs the risk of imposing severe treatment modalities onto a client. This danger is multiplied with clients who do not necessarily have the skills to oppose the treatment approaches. 
+109 
+Case 3: Joe 
+Joe was referred for both aggression and exhibitionism. He would take down his pants at the sheltered workshop, seemingly without provocation. This behavior was most likely to occur on Mondays and always after a visit home to his parents. The therapist decided to accompany Joe to his parents' home to see what might prompt this behavior. 
+The therapist saw nothing that would prompt aggression or exhibitionism. Yet, the following Monday Joe took down his pants. At that point his frontline worker realized that not only was Joe more likely to take down his pants after a home visit, but also he would ask a lot of questions about why he had been institutionalized. The staff also noted that the behavior occurred when he was scolded for some minor incident. 
+The parents were contacted and they agreed to meet with the therapist and with Joe to talk about their decision to have him live in an institution. The meeting went well and Joe asked his parents some very difficult questions. They told him that he went to the institution because he was often a "bad boy" and would not do as he was told. The therapist inquired how they handled his misbehavior. Joe's elderly mother got up from the table and went to an umbrella stand by the piano and brought out a large hollow plastic baseball bat. She indicated that she would make him take down his pants and spank him with the bat! 
+After much discussion, it was agreed that this was an inappropriate way of dealing with an adult. It was agreed that Joe would come back the next trash pickup day and would put the bat with the garbage and watch it being taken away. After this, taking down his pants was reduced dramatically and over several months disappeared altogether. 
+Again, the literature shows that developmentally handicapped individuals often are being punished for exhibitionistic behavior with techniques such as overcorrection (forced repetition and manual labor).2 This form of external control does not require any insight from the client. The image of the developmentally handi-capped as incapable of self-understanding can leave the therapist vulnerable to the use of procedures which are effective yet unnecessary when considered in light of the client's life experiences. 
+Discussion 
+It is clear from these cases that decisions for programming would have been dramatically different had not the clients' personal view of the situation been respected. Finding the meaning behind the behavior places the behavior in the context of the person's experience and individual history. Actively searching for meaning is therapeutic in itself. None of the clients described were willing or able initially to discuss the behavior from the perspective of meaning. 
+The responsibility therefore lies with therapists to challenge reductionistic assumptions of their theoretical models and to incorporate into therapy the clients' view of their own experience. Barb, Mark, and Joe would have received much different treatments had not the area of meaning been pursued. 
+Logotherapy has tremendous applications to the therapy of individuals with developmental handicaps. Frankl warned that without inclusion of logotherapeutic principles, therapists are in danger of viewing their clients as subhuman. 4 For persons working with the developmentally handicapped, the addition of logo-therapy to the usual repertoire of treatment techniques will humanize therapeutic approaches and may begin the client on a road to experiencing meaning in life. 
+DAVE HINGSBURGER is a sex therapist in Toronto, Canada. 
+REFERENCES 
+1. 
+Arnold, M.B. and J.A. Gasson, "Logotherapy's Place in Psychology." In Fabry, et al., Logotherapy in ActionJ. NY, Aronson, 1979. 
+
+2. 
+Foxx, R.M., "The Use of Over-Correction to Eliminate the Public Disrobing of Retarded Women." Behavior Research and Therapy, 14, 1976. 
+
+3. 
+Frankl, V.E., Psychotherapy and Existentialism, New York, Pocket Books, 1967. 
+
+4. 
+__, The Doctor and the Soul, Toronto,VintagBooks, 1986. 
+
+5. 
+Ghougassian, J.B., "The Rehumanization of Psychotherapy." In Fabry, et al., Logotherapy in Action, NY, Aronson, 1979. 
+
+6. 
+Greenspan, M., A New Approach to Women and Therapy. NY, McGraw Hill, 1983. 
+
+
+6. 
+Hingsburger, D.,"Logotherapy in Behavioural Sex Counseling with the Developmentally Handicapped." International Forum for Logotherapy, 12 (1), 1989. 
+
+7. 
+Penfold, P.S. and G.A. Walker, Women and the Psychiatric ParadoxJ. Montreal, Eden Press, 1983. 
+
+
+8. Rowe, W.S. and S. Savage, Sexuality and the Developmentally Handicapped, Queenston, Edwin Mellen Press, 1987. 
+111 
+An Example of a Logotherapeutic Doctor-Patient Relationship 
+Lola G6mez de Perez Uderzo 
+Dr. Alejandro 0, a well-respected surgeon, came to me 
+through his wife, with whom I had social and work connections. I knew he was ill with a spinal cord distrophia. His neurologist treated him physically but realized that an emotional element was interfering with the treatment. 
+I remembered Alejandro as independent, athletic, selfconfident, yet distant and arrogant. He always was well dressed, manicured, a hard-working, intelligent, technically efficient surgeon, a bit cold and calculating; a man who had advanced quickly in his career and reached a high economic position. 
+When I saw him in my office, he appeared old, unshaven, and untidy, with a protruding stomach. He wore slippers and leaned heavily on his wife and son. He would hardly speak because he had difficulty breathing. His face was sweaty. He told me he felt hopeless, defeated, his life meaningless. He had considered suicide as a way out, but was afraid. He expressed considerable doubt that psychotherapy would be of any benefit. 
+He described a completely gloomy future.I pointed out to him that he talked as if he were only a pair of arms and legs. I showed him that he saw himself as a one-dimensional being, not a whole human person. During the rest of the session I argued that his life was not finished, and if he decided he had no future, that was his responsibility, because he was free to choose how to face the future -either with self-pity or with dignity. 
+In later sessions he told me that the concept of freedom had a strong impact and relieved him from his hopelessness. Over the sessions, our therapeutic relationship strengthened. 
+Alejandro shared his personal history with me. He came from a poor family, the eldest of several children. His father was a strict man with whom he had always identified. His mother was a good, austere woman, emotionally distant, unexpressive of feelings, while she saw to it that her children's physical needs were cared for. As a child Alejandro stood out because of his strength and health. But at ten he suffered epilepsy and was teased at school. He studied hard and graduated with high marks. He entered medical school where he met his wife. He did well in school and became a well-known physician. 
+When we started, no one could give him a definite diagnosis. He probably had amyotrophic lateral sclerosis, and was getting worse. He had many medical tests and treatments but nothing worked. He was in despair. He could no longer perform surgery. Because of this blow of fate, his life turned into chaos. All his plans, prospects, and hopes were cut short. 
+Through our therapy he realized that teaching was a value to him. He increased his teaching and tended to accept his disease. It was the beginning of a recovery. His activity centered on teaching. He even organized and presided at some congresses. He completely abandoned ideas of suicide. 
+Then he suffered a severe physical setback. He experienced total paralysis. He could no longer come to my office. Because we had developed a deep therapeutic relationship, I saw him at his home. Night frightened him and filled him with anguish. He didn't want to sleep because he was afraid of dying of asphyxia. His father had died that way. I tried to make him see that there are things in life humans cannot control. I led him to consider his attitudinal values and face the uncontrollable. 
+He began to show some progress, could stand up with the help of a tripod, and walk a few steps. During one session we had the following conversation: Patient: For the first time the disease does not take things away from me, I take things from it. I feel almost the same as before my paralysis. I am having daily kinesiotherapy, as you suggested. I am controlling my claustrophobia. It's difficult to sleep, though less so than before. Counselor: Very good. Just don't exhaust yourself, especially for no good reason. There is time for everything. Sometimes it is better not to have too many exciting activities. It's like a child beginning to walk. If pushed to walk too soon and he falls, his learning is delayed because he's afraid. Patient: On Monday I was scheduled to inaugurate a congress, and I didn't want to go to face that situation. Yet, I did it. I have a lot of neuropathy and myopathy but the spiritual part of me is intact. I believe that in spite of my disease, I am still whole spiritually... I feel depressed with my disease. I have no diagnosis, and therefore no prognosis or treatment. The neurologist said to me: "In twenty years you're going to be crippled, but maybe you will die of something else." It's not that they haven't been concerned about me, but they have ignored the spiritual side of my disease.(His change of attitude regarding his spiritual dimension was remarkable since, as a surgeon, he did not want to accept its importance.) Look, the neurologist told my wife I should have a wheelchair at hand. But he had not seen me. I don't understand him, what does he mean? At hand? 
+Here? In the consulting room? At the university? Should hire a guy to carry the chair? Counselor: I told you several times that you are not simply a pair of arms and legs. You can choose and control your attitude in this situation. To look for the chair does not mean you have to give in to it. You can use it as temporary aid, as a useful instrument. That is intelligent. Remember that the monkey proved to have intelligence when, locked in a cage, it managed to hold a stick, an instrument, to get the banana. The monkey did not give in to the instrument. He handled it. You must do the same, until you feel confident. Like the child who begins to walk and they put him in a stroller. Sometimes this instrument enables him to move better. In your case it allows you to struggle against your physical problems. Patient: Yes, I have really managed to change the mentality of a loser that my doctors imposed on me. Now I feel a winner. Counselor: Nobody imposed anything to you! You chose to function like that. Then you realized you could choose to be a winner. (Appeal to his freedom and responsibility). Patient: I know. That's what you helped me discover, and a new horizon opened to me. I realize I am not completely limited by my disease. I am free, I can choose. 
+In May I was scheduled to go to the Logotherapy Congress in Brazil. Alejandro's ongoing therapy made me apprehensive about my trip. I felt needed. We dealt with my apprehension in a session. From Brazil I sent him a letter with some thoughts of Viktor Frankl about the meaning of pain. After my return he was improving, but suddenly suffered a setback. He developed a severe lung edema and died. When he was being taken to the hospital that night, he told his wife to let me know he was spiritually well. (He was being logotherapeutic with me.) 
+His treatment lasted six months, weekly sessions of one to two hours. I used no drugs, applied modification of attitudes, dereflection, and self-distancing. I helped Alejandro to discover his personal values. Healthy aspects were stimulated. The therapy was based on a doctor-patient relationship filled with affection. He went through a deep transformation. 
+With Alejandro the logotherapeutic role was similar to that of the family physician. After his death a beautiful affectionate link remains with all the members of his family, whom I attend whenever asked to. 
+LOLA GOMEZ DE PEREZ UDERZO, Ph.D., is a practicing psychologist in Mendoza, Argentina, and president of the Sociedad Mendocina de Logoterapia. 
+Logotherapy and the Vietnam Veteran 
+Jim Lantz and Richard Greenlee 
+Approximately four million Americans served their country in Vietnam, more than one million being exposed to hostile, life-threatening situations. 3,8 Many of these veterans still experience severe emotional pain reactive to their exposure to the horrors of this war and to their country's failure to welcome them back home in a sincere and meaningful 
+567
+way. 2, , , ,8 Alcohol and substance abuse are serious problems for some veterans who use such abuse to "numb" the pain associated with flashback episodes and intrusive memories of 
+5 6 78
+their experiences.3, , , , Logotherapeutic treatment methods can be valuable because they help the veterans discover a sense of meaning in the face of their Vietnam memories. 
+Vietnam Veteran Problems 
+It is difficult to understand why some veterans have serious emotional problems reactive to their experiences in Vietnam such as terrifying flashback experiences, powerful intrusive memories, substance abuse, emotional withdrawal, episodic discontrol, 2,5,6,7,8 while others don't. Authorities5,8 have suggested that the intensity of the symptoms is reactive to the level of horror experienced in the war, the degree of moral conflict experienced during the war, and the degree of personal culpability. A simpler formula may be more accurate in the clinical situation: the intensity of the Vietnam veterans' problems, in addition to their reaction to the amount of horror experienced, may depend on the degree of success they had in discovering a sense of meaning in their Vietnam experiences. 
+Neither the Vietnam veteran nor the logotherapist can change the amount of horror experienced during the war. What can be changed is the veterans' ability to discover a sense of meaning in their memories. This kind of meaning discovery can provide considerable relief from emotional pain 1,4 and often offers dramatic treatment results. 7,8 
+The Vietnam Veteran's Search for Meaning 
+A large proportion of American citizens believe that the United States should not have become involved in the Vietnam war.5,6 Green2 and MacPherson5 have documented the hatred and disrespect heaped upon veterans as they returned after having faced the sheer challenge of physical survival7,8 and 
+115 
+having watched many of their friends die in violent and painful ways.6,7 The important meaning-enhancement ritual of welcoming our young soldiers back home was disrupted by our country's ambivalent feelings about the Vietnam war. 6 The veterans who survived the war at times could not survive the message they received from their country that their acts of courage, suffering, and patriotism did not mean anything. 2, 5, 6, 7 ,s This message seemed to come from their government, their community, from family and childhood friends2,6,7 The failure of society to say "Thank you" frequently limited and disrupted the veteran's search for meaning. This disruption has made logotherapy an effective method of treatment. The following clinical illustrations demonstrate the potential usefulness of logotherapy with many Vietnam veterans. 
+Bob 
+The first author (J.L.) started working with Bob and his wife Beth in 1981. Bob lost his leg in a mortar attack. The original problem which was very upsetting to Beth was Bob's emotional withdrawal. When he got upset he would leave Beth and the kids and be "gone for days." Bob reported that he used this avoidance to "protect" Beth and his adolescent children. He didn't want to "explode" while he was having intrusive thoughts and flashback experiences. 
+Although Bob viewed his intrusive thoughts as bad and dangerous the therapist attempted to help Bob see that they might also have an adaptive function. He helped Bob understand that people who experience traumatic events usually undergo a healing process and that part of this process is a search for meaning in the face of the traumas. The intrusive thoughts and flashbacks might be Bob's unconscious way of attempting to discover, rediscover, and experience a sense of meaning "hidden" in his painful memories and intrusive thoughts. 
+Bob was unwilling to talk about his memories with the therapist as an outpatient, but agreed to go briefly to a psychiatric hospital so he could talk about his memories in the "safe" atmosphere of the hospital setting. Bob remained in the hospital for six weeks and got a good start to openly "talk out his memories" with the therapist in individual therapy and with his wife in marital therapy. Bob soon reported that he was beginning to develop a "feeling of meaning" about his Vietnam experiences. He started to understand the therapist's point of view that painful, intrusive memories often are an indication of meaning repression.a 
+For six years the therapist worked with the couple to help Bob continue to share his past and rediscover meaning in it. By 1987 Bob had told Beth "most of the stories." As he revealed his memories and developed a sense of meaning in his "Vietnam past" he experienced a great reduction in flashbacks and intrusive thoughts. These memories have diminished in both intensity and frequency. Bob stopped feeling afraid that he "might explode." He described everything as "fine" except that "my leg still hurts." He could not understand "how a leg you no longer have can still hurt like hell." 
+Toward the end of 1987 Bob asked the therapist to go to Washington with him to "see the wall." The therapist felt he should honor Bob's request even if it was not a "technically correct" thing to do. The trip was very emotional and powerful for both. The specific details are not as important as the fact that Bob stopped feeling pain in his absent leg once he saw and experienced the memorial. In some way the trip to the memorial wall helped Bob finally discover meaning in the loss of his leg. He has had no more phantom pain since this trip. 
+John 
+The second author (A.G.) worked with John in a residential facility for treatment of substance abuse problems. John was a retired Army sergeant major who served three tours in Vietnam. He had a serious alcohol problem. John did not believe he was alcoholic, but admitted "something was wrong." He agreed to enter treatment only because his wife had threatened to leave him if he did not seek help. What led to his admission was an incident where John became extremely violent while intoxicated, threatened his wife and family, and physically destroyed the trailer in which they were living. 
+Early in the program, John denied any major problems, but both his wife and daughter spoke of being afraid of John. His wife reported that John had recurrent nightmares of his Vietnam experiences, but refused to talk with her about them. He was quick to lose his temper and his family no longer trusted him. His alcohol consumption had increased and, tor the first time in his life, he had been charged with driving while intoxicated and tor physical assault in a bar. 
+The therapist began to explore the possibility that John was suffering from post-traumatic stress reactive to his experiences in Vietnam. When the therapist confronted John in group therapy John told the group he suffered recurrent and intrusive recollections of an event in Vietnam where his best friend had been killed and he felt responsible for the death. 
+John talked about the loss of this closest friend and his feelings of guilt about having survived while his friend did not. 
+John spoke with the group and his therapist about the tremendous shame he felt upon returning to the United States and being called a "baby killer." John stated he had entered the war "to defend democracy." He left Vietnam not understanding the purpose of this war and could no longer make sense of his involvement in that conflict. His method of coping with this loss of meaning in his life was to attempt to medicate his pain and guilt with alcohol. 
+The therapist's work focused on helping John find some meaning in the pain he had encountered in Vietnam. Through his suffering and rediscovery of meaning, John has learned the difference between survivor's guilt and survivor's responsibility. He is now committed to helping other Vietnam veterans with drinking problems. By helping others, John is now more capable of helping himself. His intrusive thoughts and nightmares have greatly lessened in intensity. John no longer fears losing control of his temper and has reestablished an intimate and meaningful relationship with wife and family. 
+JIM LANTZ, Ph.D., is assistant professor at The Ohio State University College of Social Work, a diplomat in logotherapy , and formerly served as army medic in Vietnam . RICHARD GREENLEE, MSW, is a doctoral student at The Ohio State University College of Social Work. He formerly served as an officer and social worker in the United States Air Force. 
+REFERENCES 
+1. Frankl, V., From Death Camp to Existentialism. Boston, Beacon Press, 1959. 
+2. Greene, B.,Homecoming: When the Soldiers Returned from Vietnam. NY, G.P. Putnam's Sons, 1980. 
+3. Jelinek, M. and T. Williams., "Post-Traumatic Stress Disorder and Substance Abuse in Vietnam Combat Veterans," 
+J. of Substance Abuse Treatment 1, 1984. 
+4. Lantz, J. and J. Lantz, "Meaning, Tragedy and Logotherapy with the Elderly," J. of Religion and Aging, 5, 1989. 
+5. MacPherson, M., Long Time Passing: Vietnam and the Haunted Generation. NY, New American Library, 1989. 
+6. Tick, E.,"Neglecting our Vietnam Wounds," Voices 22, 1986. 
+7. Van Devanter, L., Home Before Morning: The True Story of an Army Nurse in Vietnam. NY, Warner Books, 1983. 
+8. Williams, C., "The Mental Foxhole: The Vietnam Veteran's Search for Meaning," Amer. J. of Orthopsychiatry 53, 1982. 
+Life Meaning and the Older Unemployed Worker 
+
+John C. Rife 
+Work is a central life activity which provides economic, social, and psychological benefits. These benefits promote an ongoing sense of personal worth, life meaning, and integration during one's adult lite. However, for those who are unemployed and wish to work, the inability to obtain employment is often interpreted as a personal failure and can lead to economic and mental health problems.3, 4 ,5 ,7 
+Therapists are giving increased attention to the problems faced by unemployed older workers. These workers may face such obstacles as a changing labor market, age discrimination, and negative employer 
+stereotypes. 2 Once unemployed, older workers are more likely than others to remain unemployed beyond the length of their unemployment benefits. 1 Faced with these obstacles, they are "much more likely to abandon the job search and withdraw from the labor force than are members of other age groups". 18, P-17 They then often suffer from depression and low self-worth. 16 
+Logotherapy is useful with troubled individuals because of its emphasis on helping clients identify meaning potentials and reestablish life meanings.8, 14 The purpose of this brief paper is to discuss ways in which logotherapy may be used with the unemployed older worker. 
+Life Meaning and Unemployment 
+Frankl has stated that "man's search for meaning is the primary motivation in life". 11 ,P-121 Unemployment may result in a condition which he calls "unemployment neurosis". 9 This condition occurs when individuals become unemployed and see themselves as "useless" and subsequently believe that their life is now meaningless -a common condition among unemployed older workers. 16 In recent interviews with older workers who had been unemployed for at least four months, many stated that they 
+felt lost and without a purpose. For example, one older worker, age 56, said, 
+I worked for that company for twenty-two years and it 
+was my life's work. Now that they laid me off, what 
+should I do? I have no other skills or interests. I really 
+loved that job, the work, and my friends there. 
+These statements support Frankl's thesis that unemployment can trigger a decrease in people's ability to perceive meaning in their lives. 
+While long-term and involuntary unemployment often results in feelings of depression and uselessness tor adults regardless of age, older unemployed workers are especially vulnerable to experiencing distress. They are particularly vulnerable to employer relocation and changes in job technology. As Kreps states, "Under present circumstances, a large part of the unemployment burden rests on the older worker whose vulnerability to plant relocations, technological change, and shifts in the labor force composition is well known" 12,p. 167 Older workers have often devoted many years to a single employer and feel a great sense of loss when becoming unemployed. When suddenly confronted with the need to search for another position, they may find that employers hold negative stereotypes about older workers. For example, an employer may perceive that older workers will be inflexible, slow to learn new skills, and cost more due to absenteeism and health problems. Recent research has shown that these perceptions have little basis in fact. 2 
+In addition to these employer perceptions, societal norms for older persons are more likely to dictate disengagement from the workforce than toward reentry. Even family and friends may encourage older workers to retire without realizing that they may need to work for continued income. Older workers may also experience additional stress because of their reluctance to use public welfare services. In my interviews, most older workers had chosen not to use welfare services such as food stamps or general relief payments. One older worker stated, 
+I lived through the depression and World War II 
+without taking money from the government. I can 
+stand on my own two feet though it is getting harder. 
+Still, I won't take something (income) tor nothing. 
+I want to work for what I get. 
+Even when confronted with the possibility of losing one's home, many of these older workers resisted using welfare benefits. These attitudes seem consistent with Frankl's observation that "Man does not live by welfare alone". 9,P-26 
+The Older Worker and the Existential Vacuum 
+Frankl suggests three ways that people may find meaning in their lives: by creating work or doing a deed; by experiencing something or encountering someone; and by the attitude they take toward unavoidable suffering.1 1 The older workers I interviewed identified strongly with the importance of work in their lives. Most had worked for more than ten years with a single employer. Their lives had meaning because of the work they were doing, and because of the encounters and relationships they had on the job with others. When they were laid off because of work shortages or company closings, they reported having difficulty in finding continued meaning in their lives and 
+began to experience an "existential vacuum."9 Without the meaning which work provided to their lives, many of the older workers I interviewed reported that they experienced increased depression, anxiety, and lower satisfaction with life. These feelings entered the existential vacuum and led to continued depression. 
+The mild to moderate depression that these older unemployed workers experienced was related to their loss of employment and the impact that this loss had on their perception of life meaning. This depression can be assessed as an existential depression because it occurred in reaction to a "disruption in the person's ability to discover, create, or experience meaning" .11 ,13 Many of the unemployed older workers continued to suffer from these existential depressions for long periods because of their reluctance to experience new life events or relationships which would have provided new meaning potentials. They were unable to find other employment as a way of creating meaning in their lives, and in nearly half of the cases they simply gave up searching for employment. For these workers, their existential depressions continued. 
+Implications for the Logotherapist 
+When working with older unemployed workers, many social agencies attempt to help by giving tangible 
+121 
+assistance such as food or income, or by providing employment referrals for job interviews. Unfortunately, these agencies do not routinely address the pain and existential suffering that many of these persons are experiencing. While some older unemployed workers may need tangible financial assistance . as a result of their unemployment, therapists also need to focus on the existential vacuum which often accompanies a significant employment loss. Helping unemployed older workers to find continued meaning in their lives is an essential task in the helping process. Using logotherapeutic techniques, three activities--existential reflection, philosophical logodrama, and network intervention--can be used by the therapist to assist older workers in regaining a sense of meaning in their lives. 
+Existential Reflection. In existential reflection, the therapist demonstrates sincere personal interest and empathy while asking questions and making interpretations designed to facilitate personal reflection about the meaning opportunities and potentials which still exist in the 
+unemployed older worker's life. 1O Unemployed older workers may be feeling emotionally paralyzed because of the trauma of their unemployment experience. This paralysis may prevent them from looking toward the future and being able to set goals. In Frankl's terms, these older persons are living a provisional existence. By using existential reflection, the therapist can help the older worker become more aware of their own spirituality, life achievements, strengths, and aspirations as well as future meaning opportunities. 
+Philosophical Logodrama. This technique can be used to assist the older worker to find meaning in his or her life and is based on the work of Sahakian. 17 The logotherapist asks that the older workers imagine themselves to be in old age, and to discuss the life activities they would most like to have accomplished. As Sahakian notes, this discussion will help both the client and the therapist to identify "what is most meaningfully worthwhile in life". 17,p.33 If continued employment emerges as a valued activity, appropriate guidance and referrals can be provided. If other activities, such as volunteer work or family relationships are ranked higher, they can be given attention. 
+Network Intervention. To facilitate implementation of the older worker's rankings of meaning potentials, network intervention can be used. In his own logotherapy work, Frankl has used volunteer employment to provide meaning opportunities for 
+unemployed persons.1 1 These volunteer experiences provided the unemployed with a meaningful activity which aided in the relief of their depression. Volunteer experiences can provide the opportunity for the older unemployed worker to reestablish a sense of meaning by engaging in new social activities and relationships. In addition, other forms of network intervention can be used which are more specifically targeted toward helping older workers regain employment. For example, they might be enrolled in a job club program where they can benefit from affiliation with other unemployed older workers who are also interested in finding a job. Participants in these programs often report feeling a sense of renewed life meaning because they are helping others like themselves to find employment. One older worker who had participated in this type of program stated, 
+I learned that I wasn't all alone being unemployed, 
+that many others were just like me. We supported 
+each other and I began to feel good that I was helping 
+others to find a job. Eventually, I found one, too. 
+JOHN C. RIFE, Ph.D. is assistant professor of Social Work at Indiana University East, Richmond, Indiana. 
+REFEFENCES 
+1. 
+Atchley, R. Social Forces and Aging: An Introduction to Social Gerontology. Belmont, California, Wadsworth Publishing, 1985. 
+
+2. 
+Barron, G. Aging, the Individual, and Society. St. Paul, West Publishing. 1989. 
+
+3. 
+Braginsky, D. and 8. Braginsky, "Surplus People: Their Lost Faith in Self and System". Psychology Today, .9., 69-72, 1975. 
+
+4. 
+Brenner, M. Mental Illness and the Economy. Cambridge, Massachusetts: Harvard University Press, 1973. 
+
+5. 
+Briar, K. The Effect of Long-Term Unemployment on Workers and Their Families. San Francisco, C & E Research Ass., 1978. 
+
+6. 
+__. "Helping the Unemployed Client", Journal of Sociology and Social Welfare, L 895-906, 1980. 
+
+
+123 
+7. Buss, T. and F. Redburn. Mass Unemployment: Plant Closings and Community Mental Health. London, Sage. 1983 
+8. 
+Fabry, J. "The Frontiers of Logotherapy", The International Forum for Logotherapy, ~(1), 3-11, 1981. 
+
+9. 
+Frankl, V. The Unheard Cry for Meaning. New York, Washington Square Press, 1978. 
+
+10. 
+__ The Unconscious God. New York, Simon and Schuster, 1975. 
+
+11. 
+__ Man's Search for Meaning. New York, Washington Square Press, 1959. 
+
+12. 
+Kreps, J. "Age, Job Performance, and Job Opportunity", in M. Purvine (ed.), Manpower and Employment: A Sourcebook For Social Workers. New York, CSWE p. 167, 1972. 
+
+13. 
+Lantz·, J. and K. Harper. "Network Intervention, Existential Depression, and the Relocated Appalachian Family", Journal of Contemporary Family Therapy, 11, 213-223, 1989. 
+
+14. 
+Lantz, J. and J. Lantz. "Meaning, Tragedy, and Logotherapy with the Elderly", Journal of Religion and Aging, 5., 43-51, 1989. 
+
+
+15. Purvine, M. Manpower and Employment: A Sourcebook For Social Workers. New York: CSWE p. 11, 1972. 
+16. 
+Rife, J. and R. First. "Discouraged Older Workers: An Exploratory Study", The International Journal of Aging and Human Development, 29 (3), 195-203, 1989. 
+
+17. 
+Sahakian, W. "Logodrama and Philosophical Psychotherapy". The International Forum for Logotherapy, -9. 33-38, 1986. 
+
+
+18. U.S. Department of Labor. Employment-Related Problems of Older Workers: A Research Strategy. USDLR & D Monograph. 
+U.S. Government Printing Office, Washington, D.C. 1979. 
+An Experimental Investigation of Viktor Frankl's Theory of Meaningfulness in Life 
+A. A. Sappington, John Bryant and C. Oden 
+Frankl5 proposes that finding a sense of purpose in life is essential to physical health and psychological adjustment. Crumbaugh's Purpose in Life (PIL) Test 1 measures the extent to which people perceive their life as meaningful. 
+Other efforts to objectively measure meaningfulness include the Existential Study11 and the Alienation Test.8 Research with these instruments provides support for Frankl's beliefs about the relationship between effective functioning and meaningfulness. When compared with people who see little meaning in their lives, those who see much meaning tend to: 
+•Score 
+lower on the Depression subscale of the MMPI.1 
+
+•Be 
+less likely to be alcoholics, unwed mothers, or schizophrenics. 9, 11 
+
+•Score 
+higher on creative attitudes toward living.8 
+
+•Spend 
+less time with TV or in solitary activities.3 
+
+• 
+Be more resistant to illness or psychological problems in stressful life situations.7 
+
+•Be 
+less likely to be drug abusers.6 
+
+
+Frankl's theory has thus proved useful in predicting a relationship between effective functioning and purpose in life. However, Frankl says that purpose in life plays a causal role in this relationship. Because the data cited are correlational, they do not allow for causal conclusions. While Frankl would suggest that a sense of life purpose makes people more resistant to physical or psychological problems and less likely to turn to such escapes as drug abuse or heavy TV watching, the direction of causality could conceivably run the other way. It might well be, for instance, that those who do not have to deal with problems such as drug abuse or unwed motherhood have more time and energy to search out the meaning of life. To determine the direction of causality between meaningfulness and effective functioning, it is necessary to be able to increase the sense of meaningfulness in people's lives. 
+Frankl's theory suggests that meaningfulness can be increased through any of three general approaches: by "giving to the world" through creativity or by helping others; by "taking from the world" through increasing enjoyment and appreciation; and through the attitude toward inevitable suffering. The first two approaches suggest specific interventions. Clients can be taught to "give to the world," for instance, by assigning a set of helping activities; they can be taught to "take from the world" by assigning a set of pleasurable experiences. Changing "attitudes toward inevitable suffering" is the least specific of the three approaches. With such measures as the Purpose in Life Test available, it is possible to evaluate the effectiveness of each of those approaches for increasing meaningfulness, and thus to shed some light on the usefulness of Frankl's theory. 
+Logotherapy uses all three approaches for increasing meaning. Research2 suggests an increase in meaning as measured by the PIL Test. Consequently, logotherapy may offer one tool for investigating the causal relationship of meaning and effective functioning. However, logotherapy is a complex technique requiring considerable skill; any two practitioners might use the technique differently. To explore the relationship between meaning and effective functioning, more standardized techniques for increasing meaning would be equired. Further, Frankl's theory -as compared to his therapy techniques such as paradoxical intention -has attracted relatively little research. It would be desirable to evaluate each of Frankl's approaches for increasing meaning separately in order to understand more about his theory. 
+Our study evaluates Frankl's theory by assigning activities designed to increase perceived meaningfulness by helping subjects "give to the world" or "take from the world." Insofar as these procedures are effective in increasing perceived purpose, they confirm Frankl's predictions about the conditions under which perceived meaningfulness can be increased. They will also make possible to evaluate the causal role of meaningfulness in effective functioning. 
+Experiment 1 
+Subjects: 105 students taking introductory psychology were given a battery of tests, including the PIL, at the start of the quarter. Students scoring in the lowest quartile on the test were invited to participate in an experiment investigating methods of changing the way in which people view themselves. Fourteen females and six males served as subjects. 
+Measures: The PIL Test was used to assess perceived meaningfulness. The Rosenberg Self-Esteem Scale and the Fear of Negative Evaluation Test were given to make the purpose of the study less obvious; no treatment effects were expected on these measures. Subjects were asked to indicate on a five-point scale the extent to which they felt confident that their treatment would be effective in changing the way they saw themselves. Essay questions asked: "What do you think this experiment was about?" "What do you think we wanted you to do during this experiment?" "What do you think we wanted you to do on the PIL questionnaire?" The extent to which answers to these questions indicated that subjects were aware of what we wanted them to do was evaluated by raters blind to the subjects' experimental condition. 
+Treatment booklets: All subjects were randomly given one of two booklets prescribing daily exercises to be completed during the next week. Experimental subjects were given a booklet asking them to mentally go through their daily routines for the next week and list on a special sheet all opportunities for doing something nice for others that would require minimal time and effort (e.g. letting someone into your line of traffic on the way to school; speaking to the cafeteria workers). They were to review this list each morning before leaving for work or school and to put a check mark on a record form to indicate that they had done so. In the evening, they were to go back over the list and put check marks by the opportunities they had taken advantage of, and also to list any unique opportunities for doing something nice that they had taken advantage of. This booklet is presented in Sappington. 10 Subjects in the placebo group were given "Power of Positive Thinking" booklets and asked to list each day positive news stories learned through the media. 
+Procedure: All subjects took the original battery of measures, administered by their teachers, at the beginning of the quarter. After one month those who qualified for the study were invited to participate. Those who agreed picked up their booklets from a secretary. Thus, the phone call served as the only contact with the experimenters until after completion of the exercises. Subjects were asked to bring their record sheets with them to the post-treatment session where they turned in their records and retook the PIL, the Self-Esteem, and the Fear of Negative evaluation measures. They completed the five-point scale and the demand characteristics questions. The purpose of the study was then explained to them.Subjects in the control group were offered the experimental booklets. 
+Results: The mean scores of the experimental and control subjects on the PIL Test before and after treatment are shown in Table 1. The experimental subjects increased their Purpose in Life scores more than did the control subjects. Results were analysed by a two-way analysis of variance with repeated measures. A planned comparison revealed that the treatment subjects increased their scores significantly more than did the control subjects (F, 1 & 18df, = 7.806, alpha less than .025). No significant difference was found between the two groups on the treatment confidence rating scale. No differences in awareness of the purpose of the experiment were found for the essay questions. No significant differences between _groups were found on the Self-Esteem or Fear of Negative Evaluation measures. The record-keeping forms indicated that all subjects had followed instructions. 
+Experiment 2 
+Subjects: 89 students taking introductory psychology took a battery of tests including the PIL Test at the beginning of the quarter. Those scoring in the bottom third were invited to participate in the study; 15 females and 9 males participated. 
+Measures: These were the same as in Experiment 1. 
+Treatment procedures: Subjects were given booklets similar to those in Experiment 1, except that this time they were asked to list routine opportunities for enjoyment that would require little time and effort (e.g. cutting through a park on the way to class). This booklet is also presented in Sappington. 10 Record-keeping was the same. Placebo control subjects were told they were to undergo a subliminal message procedure similar to those used in many commercial self-help tapes. They were brought in for an initial session in which they listened to an Earl Klugh tape (jazz guitar) on which had been imposed a series of statements such as "I am a worthwhile person" and "I have much to be proud of' played backwards. This procedure was described as a subliminal message treatment which presented positive self-statements to the unconscious mind. Although subjects could hear a voice in the background, none could make out the message. They were instructed to mentally replay the music each morning and each evening, and to indicate on a record-keeping form that they had done so. They were told that this procedure would help change their self-image positively through subliminal conditioning. 
+Procedure: The same as in Experiment 1 except as described above under "treatment procedures." 
+Results: The mean scores of the experimental and control subjects on the Purpose in Life Test are shown in Table 
+2. The experimental subjects increased their scores more than did the control subjects. Results were again analyzed by means of a two-way analysis of variance with repeated measures. A planned comparison revealed that the treatment subjects increased their scores significantly more than did control subjects (F, 1 & 22df = 12.817, alpha less than .01). No significant differences were found between the groups on treatment confidence, awareness of purpose of experiment, self-esteem, or fear of negative evaluation. 
+Discussion 
+These data suggest that techniques derived from two of the three general approaches which Frankl says should increase perceived meaningfulness of life, "giving to the world" and "taking from the world," are indeed effective in increasing Purpose in Life scores. Taken together with the correlational research linking meaningfulness with a highlevel functioning in various life areas, these data suggest that Frankl's theory has more utility as a scientific theory than has generally been recognized. Also, the availability of specified techniques for increasing meaningfulness make possible the investigation of the causal role played by perceived meaningfulness in effective physical and psychological functioning. Such an investigation should tell us still more about the utility of Frankl's theory. 
+Because few laboratory tasks have been related to meaningfulness, clinical studies will probably be required to determine the effects of increasing purpose in life. Two such experiments are planned. The first will study cancer patients undergoing radiation therapy. The effects of increasing perceived meaningfulness upon quality of life and physiological functioning will be determined. The second will study drug abusers. The effects of increasing perceived meaningfulness of life upon relapse will be examined. Such dependent measures as amount of TV watching might also prove useful. 
+One remaining need is for studies to possibly increase perceived meaningfulness of life by altering "attitudes toward inevitable suffering." Better controlled evaluations of logotherapy might prove useful here, as might studies investigating the effects of certain portions of cognitive therapy upon perceived meaningfulness. It would also be interesting to investigate variations of the "giving to the world" or "taking from the world" approaches. Exercises designed to increase creative activity would be an example of the former, and courses designed to increase appreciation of art or nature might be examples of the latter. 
+Table 1 -Mean Scores on Purpose in Life 
+for experimental and placebo groups before and after treatment of "giving to the world" (activities) 
+Before After Experimental 89.1 1 0 0. 5 Placebo 93.4 97.9 
+Table 2 -Mean Scores on Purpose in Life 
+for experimental and placebo groups before and after treatment of "taking from the world" (experiences) 
+Before After Experimental 101.000 109.333 Placebo 1 0 1 . 1 6 7 99. 750 
+A. A. SAPPINGTON, Ph.D., is associate professor, Dept .of Psychology, The University of Alabama at Birmingham. JOHN BRYANT and CONNIE ODEN were undergraduate students at the University of Alabama at the time of the study. 
+REFEFB\CES 
+1. 
+Crumbaugh, J_ C.,'Cross Validation of the PIL Test based on Frankl's Concepts." J. of Individual Psychology, 24, 1968. 
+
+2. 
+___ 'Changes in Frankl's Existential Vacuum as a Measure of Therapeutic Outcome" Newsletter f. Res. in Psychology, 14, 1972. 
+
+3. 
+Csikszentmihalyi, M., Beyond Boredom and Anxiety. SF, Jossey-Bass, 1975. 
+
+
+4. Ellis, A.,Reason and Emotion in Psychotherapy . .NY, Lyle Stuart, 1962. 
+5. 
+Frankl, V., Man's Search for Meaning. Boston, Beacon Press.1962. 
+
+6. 
+Harlow, Lisa L., M. D. Newcomb, and P.M .. Bentler, "Depression, Self Derogation, Substance Abuse, and Suicide Ideation: Lack of Purpose in Life as a Mediational Factor. J. of Clinical Psychology, 42, 1986. 
+
+7. 
+Kobassa, S. C., "Stressful Life Events, Personality, and Health" J. of Personality and Social Psychology, 37, 1979. 
+
+8. 
+Maddi, S. R., S. C.Kobassa, and M. Hoover., 'An Alienation Test." J. of Humanistic Psychology, 7, 1979. 
+
+9. 
+Pishkin, V. B. and F. C. Thorne, "A Factoral Study of Existential State Reactions." J. of Clinical Psychology 29, 1973. 
+
+
+10. Sappington, A.A., Adjustment: Theory, Research and Personal Application. Pacific Grove, Brooks/Cole, 1988. 
+11. 
+Thorne, F. C., "The Existential Study: A Measure of Existential Status." J_ of Clinical Psychology 2 9, 1973. 
+
+12. 
+___ and V. Pishkin., 'The Existential Study." J. of Clinical PsychologyL2 9L 1973. 
+
+
+Meaning in Drug Treatment Kevin W. Olive 
+Frankl posits that meanii1g in life is available in all 
+circumstances; the ability to discover it is available to everyone; and that it is the primary motivator for behavior. Meaning is defined as those "idiosyncratic moments, values, people, experiences, tasks, attitudes, etc. that constitute one's sense of uniqueness and reason(s) for living." In this article, drugs are seen as a source of artificial meaning as opposed to authentic meaning. An artificial source of meaning is a way of covering up a life devoid of authentic meaning. 
+Fabry1,p.30 states that "logotherapists could show [that) ... students try to fill [existential vacuum) with drugs." Fabry and Lukas2 suggest that the addition of logotherapy to traditional therapies should prove more effective in the treatment of drug addicts. 
+Currently, the National Institute on Drug Abuse is conducting a study on intravenous drug addicts (IVDA) not in treatment and their sexual partners. At 63 sites, social scientists are using ethnographic methods of observation of the IVDAs in.their native environment (namely the streets) and at designated outreach centers set up by the research projects. 
+At present, an estimated six out of seven IVDAs are not in drug treatment. They are not receiving drug treatment nor do they receive the substantive AIDS preventative education that drug treatment programs now offer. 
+Present substance abuse intervention strategies are limited to sanction or substitution. These strategies focus on: 
+• 
+Sanction of the behavior through incarceration 
+
+• 
+Substitution of another source of meaning such as "God" in Christian-based therapies 
+
+• 
+Techniques to convince addicts that their behavior is dangerous and should be stopped 
+
+• 
+Substitution of another drug such as methadone(dolophine hydrochloride) for the narcotic 
+
+• 
+"Chemomaintenance" using drugs such as bromocriptine and imipramine to replace the dopamine (a neurotransmitter) in the brain that has been depleted by cocaine. 
+
+
+Sanction treatment -legal sanctions by mainstream society -provides a controlled environment (i.e., prison) for specified periods for law-breaking individuals. While drugs may be more difficult to obtain in prison, many addicts return 
+. 131 
+to drugs upon release. Sanctions may cause more of a problem because they provide a perceived "common enemy" by which addicts bind together into sharing communities. 
+The Christian-based therapies and those designed to convince the addicts that drugs are dangerous have had varying reported rates of success. However, the addicts return to the drug subculture that gave them an artificial source of meaning and a sense of belonging and self-esteem. This self-esteem is derived from the self-value given to the addict through the sharing of drugs and needles, the risk of possible arrest, and experiences with other addicts. This sense of community binds addicts together as a subcultural group with its own social rules, expectations, and obligations. Because of their feeling of community, the addicts are willing to take larger risks, such as sharing needles and risking HIV infection. After all, why would their partners give them HIV through sharing needles? Even where addicts were shown how to clean needles before sharing, they felt that "if my sharing partners see me cleaning the needle, they will assume that I do not trust them." 
+Therapies that substitute legal for illegal drugs only supply another artificial source of meaning. Methadone is used to substitute for heroin. Bromocriptine and imipramine are used to replace cocaine. They replace the lost dopamine believed to be related to the brain's "reward system." These drugs prevent the "drug craving" associated with withdrawal from cocaine. This treatment affects only the ·physical dimension of the addicts but their humanity, their meaning in life (the noetic dimension) is not addressed and many return from this intervention with no real sense of meaning. 
+What, then, is the best route to intervention? Present methods are lacking in addressing, much less assisting, the patient in discovering "authentic" meaning. Treatment of the addict as a human being with an individual purpose in life remains largely untouched by present-day therapy available to IVDA individuals. 
+KEVIN W. OLIVE, M.A..is psychiatrist at Affiliated Systems Corporation, Houston, Texas. 
+REFERENCES 
+1. 
+Fabry, J., The Pursuit of Meaning, Berkeley, CA, Viktor Frankl Institute Logotherapy Press, 1987. 
+
+2. 
+__ and E. Lukas, "Drug Addicts Need Meaning, Too." Uniquest: The Search for Meaning, L 30-32, 1977. 
+
+
+Frankl's Mountain Range Exercise A Logotherapy Activity for Small Groups 
+Florence I. Ernzen 
+In The Doctor and The Soul, Frankl invites us to spread our lives out before us like a beautiful mountain range. What would we put on the peaks? Wouldn't even a few model lives, a few intellectual or ethical geniuses, or even a single individual whom we truly love, make all the difference in how we view our life as a whole? 
+Group Exercise 
+Participants are given an opportunity to look out over their life as one would look out over a mountain range. As they look out what do they see? Whom would they place on the peaks that stretch out before them? Who are the people who have influenced their life? They may include authors, leaders, or people in their personal life who have loved them, or whom they have loved. 
+Participants are given paper, colored pencils or markers and time to sketch out their range. Then they are given the opportunity to discuss who "appeared" on their peaks. Many people are surprised at the appearance of a teacher, author, or neighbor they had not thought of in years. Their appearance rekindles the values or lessons that influenced them. 
+Participants are encouraged to look for recurring values. Some participants have recalled the empowerment of a teacher or a family member. In a class in which this exercise was used a woman discovered the riches in her relationship with her parents. Both parents had died and she was feeling that all was lost. Through the exercise and class she found that they had contributed much to ·her life. It was not lost. It was all part of her life's fabric. She was full of gratitude for their influence. 
+Reports from Other Logotherapists 
+Robert Hutzell, psychologist at the Knoxville, Iowa, Veterans Hospital uses the exercise frequently with patients in the alcohol treatment unit and with groups of psychiatric inpatients (mostly with schizophrenic diagnosis). Usually he uses the activity to help patients focus on values of other persons that the participants may have incorporated into their own value system. Occasionally, he uses the exercise to help participants realize that there have been positives in their lives. 
+He writes in a letter that he administered the PIL Part A at the beginning of the session with seven psychiatric inpatients. Then he conducted the mountain range exercise. Then he asked the patients to review the 20 PIL items and note any changes in their answers they felt would be appropriate due to changes in their thinking that had occurred during the exercise. Five of the patients made changes on one or more PIL items: item 2 (life seemed more exciting), item 4 (their life seemed more purposeful), 5 (their days seemed less monotonous) and 8 (they made more progress toward life goals). One person showed a decreased score on item 15 (less frightened of death). Two persons showed an increased score on items 6 and 19, suggesting that the exercise resulted in feelings that if the patient could choose, they would like more lives just like this one, and suggesting that the patient felt that facing their daily tasks became an increased source of pleasure and satisfaction. 
+Summary 
+The Mountain Range Exercise is a helpful logotherapeutic exercise. It has been used with retreat groups, meaningful living groups and psychiatric inpatients. It assists participants in looking at their lives from a different perspective. Through it they discover recurring values, recognize their uniqueness and broaden their life view. It is an unfolding exercise--a way of looking at life. Years after teaching a logotherapy class which incorporated this exercise, I have received letters from class members informing me they have just added someone new to their range. 
+FLORENCE I. ERNZEN, MSW, Diplomate in Logotherapy, is a school social worker in Wyandotte, Michigan, and a logotherapy retreat leader and teacher. 
+The International Forum for 
+LOGOTHERAPY 
+Journal of Search for Meaning 
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