Volume 15, Number 1 Spring 1992 
The International Forum for Logotherapy, 1992, 15, 66-70. 
MEANING IN INDUSTRIAL SOCIETY 
Viktor E. Frankl 
The question of meaning in industrial society is raised frequently in logotherapeutic discussions. Unfortunately, there has been very little written about it, although practice has shown favorable results. The following article is a condensed report by Dr. Franz Vesely of an address by Professor Frankl in 1983 at a management symposium in France. 3 
Frankl started by pointing out that the question of meaning in industrial society concerns not merely life's meaning but the more fundamental question of the possibility of such meaning. Increasingly, people express doubt whether the question is indeed answerable. A clinic in California reported that 30% of its patients saw no meaning in their lives, and this "existential vacuum" was also reported in Western Europe, the eastern bloc, and the developing countries. "Today's psychiatrists," Frankl told the audience, "have to deal not with sexual but with existential frustration--not with a frustrated Freudian pleasure principle, which we might call a 'will to pleasure,' not with a frustrated Adlerian 'will to power,' but with a frustrated 'will to meaning.'" 
The symptoms of such frustration are well-known: boredom, a lack of interest, and apathy, a lack of initiative. "People today have no real interest in the world and lack the initiative to try and change it." 
This spreading meaning vacuum is especially evident in affluent industrial countries. "People have the means for living, but not the meanings." Suicide rates are especially high in countries like Austria and Sweden, where a firm net of social security precludes serious material misery. 
Unemployment 
The unemployed are in particular danger. They, too, are protected by social security, yet there are suicides, crises, and psychological illnesses. Between the two world wars Frankl worked with the unemployed in a counseling center sponsored by the unions. He discovered that the principal cause of depression and despair was not unemployment but a faulty interpretation, in a twofold sense: they equated unemployment with being useless, and being useless with a meaningless life. Frankl succeeded, so he 
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reported, in placing his (mostly young) clients as volunteer help in adulteducation schools, public libraries, and youth organizations. They didn't get a penny for their work. Their economic situation was not changed at all. Yet their depression, caused by their feeling of meaninglessness, vanished as soon as they were given a chance to fulfill tasks they considered meaningful. But this very thirst for meaningful tasks remains unfulfilled today, despite all efforts to supply social security. "I can only say this," observed Frankl, "people don't live by social security alone." 
Similar problems in psychological health, Frankl added, arise from today's trend toward increasingly shorter work hours. He quoted an American student: "We have developed a welfare state that guarantees survival without personal effort. When some time in the future technology will make it possible for 15% of the American work force to supply the needs of the entire nation, two questions will have to be answered: which 15% will work, and what will the rest do with their free time--and their loss of meaning? Logotherapy may have to say more to America in the next century than in the present." 
The same, Frankl maintained, is true for early retirement. In our industrial society which values efficiency, the young, because of their higher efficiency, are more appreciated, even idolized. At the same time, people are retired early. So the feeling of having lost their work is added to the feeling of having lost their youth. 
Not only do the unemployed suffer from a frustrated longing for meaning but so do workers and managers. Workers demand work they consider meaningful. Frankl quoted reports from psychiatrists of all schools whose offices are full of patients who, despite good pay and external success, see no meaning in their work. One author put it squarely: "The next wave of personnel entering industry will be interested in careers with meaning, not money." Frankl also quoted the report of a TV correspondent who had lived for years in Poland: 'The Poles would work 60 hours a week, if they knew their work had meaning, but they don't want to work at all as long as they don't see any meaning in it." (Note: this lecture was given in 1983.) 
And the employers, bosses, and managers? Contrary to general opinion, Frankl sees little danger in an overload of responsibility and stress: 'The belief that managers become sick because of stress caused by too much responsibility is absolutely false and this has long been scientifically established. Certain kinds of stress are not unhealthy, people even need stress--the tension between what they are and what they could be, between their at.,~uality and their potential. This stress, correctly dosed, is psychologically healthy. In any case, one cannot say stress in itself causes illness. Next to dis-stress 
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there is also eustress, healthy stress, as the creator of the stress theory, Hans Selye, has named it. 
Frankl rejected another popular term: self-actualization. "Abraham Maslow, the founder of humanistic psychology, confirmed in his later writings: Frankl is right, self-actualization can never be a goal because then it will be missed." The question of self-actualization cannot be separated from the question of meaning. "Socrates knew this 2,500 years ago. He told his friends and his students: I have the possibility to become a criminal. Imagine if Socrates, instead of being a teacher, would have become a criminal--this, too, would have been self-actualization, realization of a potential. You have to make choices. Making choices is a question of values, and that is a decision of conscience, whether you want to actualize this or that of your potentials, your decision for the what-for. And that makes sense only if your decision is in the direction of a meaning--there was more meaning in Socrates becoming Socrates than a criminal." 
The midlife crisis, too, from which managers often suffer, Frankl sees as a meaning crisis. Rolf van Eckartsberg surveyed Harvard graduates 20 years after their graduation and found that a significant percentage, most with successful careers and orderly and outwardly happy lives, complained about a deep-seated feeling of meaninglessness. Frankl reported from his own practice: "I remember a high-ranking American diplomat who had been transferred to Vienna and wanted to continue his psychoanalysis of five years in New York. I asked him why he wanted to be psychoanalyzed. He said his analyst told him he had to make peace with his father image. He didn't agree with U.S. foreign policy, which means he hated his father because foreign policy, president, and government are father images. He and his analysts didn't see the forest of reality for the trees of the images. I saw the man twice and told him, you have no neurosis, you don't need psychoanalysis, you are simply dissatisfied with American foreign policy. He told me he would like to switch to a career in the oil industry but the analyst said no, he had to make peace with his father. And so he went through psychoanalysis for five years. I gave him the green light, and told him he should do what he considered meaningful. Six months later he wrote me from Singapore that he was the happiest man imaginable." 
Work in Sociology 
Frankl reported on logotherapeutic work by a number of German and American sociologists and management specialists. "Managers who want efficiency in work must offer meaning in work," he quotes the German 
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sociologist Walter Bockman. Oliver A. Phillips, department manager for various aerospace companies in California who studied with Frankl, writes: "Management cannot dictate what [the employees'] work meaning should be. It can only provide [them] with a freedom of responsible choices. This single concept of logotherapy probably has had the most far-reaching effect in management theory ...As a result of this management system, absenteeism was reduced to 1 % compared with the 'normal' 5%, and production was 20 to 30% higher than in comparable plants. In Yugoslavia and China, management is emerging that uses meaning orientation as incentive to work. In Israel workers are motivated by a will to meaning expressed in the betterment of their society and in the service of their community.4 
A discussion about meaning in industrial society would not be complete without exploring the situation of the young. Frankl can draw from his early experiences with youth advisory centers in Vienna and other European cities. He sees a drastic change in the problems of today. In the twenties and thirties, the young went to the advisory centers because of sexual problems; today primarily because of existential questions about the meaning of life, and connected with it, problems of suicide. Young people see life and the future closely linked. If they see no meaning in life, they have no future, with strong implication for their work situations. The young people who describe themselves as the "no-future generation," are lost in boredom and apathy, they lose all interest and initiative. The consequences are well-known. Frankl quoted a "man of the street" as witness. On the way to the University of Georgia, where students had invited him to speak on 'Is the new generation mad?' he asked the taxi driver, an old Negro, about his opinion. The old man answered: "Of course, they are. They take dope, they kill each other, and they kill themselves." In psychological terms, Frankl told his audience, this translates into the triad of mass neurosis--aggression, addiction, and depression. 
Aggression, addiction, and depression, according to Frankl, are consequences of existential vacuum. He supports this view with statistics and experiences of psychologists and therapists. "Louis S. Barber, one of my American students, proved statistically that a feeling of meaninglessness is a decisive factor driving youth to criminality. In a rehabilitation center for juvenile delinquents, where he applied logotherapeutic principles, he achieved 87% rehabilitation without recidividism. 1 Alvin S. Fraiser, another one of my American students, headed a rehabilitation center for drug addicts and reports a 40% full rehabilitation, compared with an average of 11 %. He sees a meaning-oriented logotherapeutic milieu as essential."2 As to suicide, Frankl 
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said: "I don't believe that every suicide is committed because of a feeling of meaninglessness. I know that it could have been prevented if the person had seen a task to which he or she was committed as a matter of personal conscience, and not because it was demanded by parents, teachers, or society. That's why prevention can be achieved only by orientation toward meaning, and confrontation of tasks, challenges." 
How can we help people find meaning? Frankl declared: "Meaning can not be given; it has to be discovered." Neither can it be "prescribed." The task of logotherapists is to make clear to patients that meaning exists, under all circumstances, to the last breath, and help them find it through demonstrating various meaning possibilities. In a few words Frankl outlined his value theory: He defined three main roads to meaning: through a deed, work; through experience (art, nature, beauty, truth, love); and through a change of attitude-but only in cases where a meaningless situation cannot be changed. As an example of the latter, Frankl told about Jerry Long of Texas who became quadriplegic after a diving accident at the age of 17. With a little stick between his teeth he typed a letter to Frankl, containing the sentence: "I broke my neck, it didn't break me." Jerry finished high school and studied psychology. (Note: In 1990 he received his Ph.D., and now teaches University courses and counsels others who suffer quadriplegia and other physical challenges.) Quoting again from his letter to Frankl: "I know that without my suffering, the growth that I have achieved would have been impossible." 
VIKTOR E. FRANKL, M.D., PH.D., is the founder of Logotherapy and Professor of Psychiatry at the University of Vienna, Austria. 
References 
1. 
Barber, L. S. (1979). Juvenile delinquents. In J. Fabry et al. (Eds.), Logotherapy in Action. NY: Jason Aronson. 

2. 
Fraiser, A. R. (1979). Narcotics. In J. Fabry et al. (Eds.), Logotherapy in Action. NY: Jason Aronson. 

3. 
Frankl, V. E. (1984). Die Sinnfrage in der industriegesellschaft. In Gesellschaft und Wirtschaft im Umbruch und Aufbruch. Paul-de-Vence: Sperry International Management Centre. 

4. 
Phillips, 0. A. (1979). New course for management. In J. Fabry et al. (Eds.), Logotherapy in Action. NY: Jason Aronson. 


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The International Forum for Logotherapy, 1992, 15, 71-75. 
MEANING, PURPOSE, AND LEADERSHIP 
Robert A. Levit 
Leadership has been defined as a process for giving meaningful direction to collective effort, and causing willing effort to be expended to achieve purpose.3 Skills underlying leadership are specified in expanded definitions which include how "willing effort" is achieved. For instance, leadership requires a communication to be harnessed to an inner vision, which captures the future in a metaphor that strikes a resonant chord in a constituency. The impact of such skills is amplified when we observe the outcome of successful leadership--people achieving results that go beyond reasonable expectations. 1•2 
In this paper, it is hypothesized that the motive force behind the leader's influence is meaning and purpose. The many definitions of leadership are thus extended to include: Leadership is the clarification of purpose and meaning for others. 
If leaders are to clarify purpose and meaning for others, it is suggested that they themselves will have a greater-than-average sense of purpose and meaning. To test this hypothesis, business executives completed an empirical measure of leadership (the Leadership Effectiveness Analysis-LEA) and the Purpose In Life (PIL) test. Significant correlations between the LEA and the PIL score would support the hypothesis that a strong component of purpose serves as a foundation for leadership. 
Leadership Effectiveness Analysis 
While the PIL test4 is familiar to most Forum readers, the Leadership Effectiveness Analysis (LEA) is not. The LEA is a management development tool that measures 22 dimensions of leadership clustered into six overall leadership roles.8 The roles and dimensions measured by the LEA are as follows: 
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Creating A Vision. This role measures a leader's skill in creating a future state to which others will give credibility and commitment. Specific dimensions are: Conservative--the degree to which a leader allows past events to influence the present; lnnovative--the degree to which a leader can look at issues from a fresh viewpoint; Technical-the degree to which a leader needs data to make decisions; Self--the degree to which a leader is comfortable making decisions based on his or her own perceptions; and Strategic--the degree to which a leader uses the "big-picture" in decision making. 
Developing A Followership. This role measures the leader's ability to engage others in the accomplishment of the vision. Specific dimensions are: Persuasive--the effective use of language to communicate objectives; Outgoing--the degree to which a leader is extroverted or at ease in public settings; Excitement--the degree of emotion the leader brings to his or her work; and Restraint--the degree to which emotion is controlled when necessary. 
Implementing The Vision. This role measures the ability of the leader to move from the abstraction of a vision to its concrete realization. Specific dimensions include: Structuring--the ability to ensure that tasks are accomplished; Tactical--the degree to which the leader participates in the "action"; Communication--the degree to which the leader keeps others informed; and Delegation--the degree to which the leader allows others to share in task accomplishment. 
Following Through. This role measures the leader's ability to monitor progress toward the realization of the vision. Specific dimensions are: Control--the degree to which the leader tracks accomplishments; and Feedback--the degree to which the leader manages performance through coaching and communication. 
Leadership Style. This role measures the leader's characteristic approach to the leadership situation. Specific dimensions are: Management Focus--the leader's readiness to assume responsibility; Dominance--the leader's ability to be assertive when required; and Production--the degree to which the leader creates an environment for achievement. 
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Team Playing. This role measures the leader's ability to coordinate the work of others to accomplish the vision. Specific dimensions are: Cooperation--the degree to which the leader works with others on goals; Consensual--the degree to which the leader shares the decision-making process; Authority--the degree to which the leader "bows" to those in superior positions; and Empathy--the degree to which the leader emotionally understands others. 
The validity and reliability of the LEA have been established by its author.8 Test-retest reliability ranged between +.73 and +.89. Content validity, measuring the overall agreement between the self-perceptions of respondents and those of outside raters, yielded correlations between +.46 and +.81 (M= +.61). Over 3500 managers and leaders have completed the LEA, establishing a data base and making the instrument suitable for research. 
The Approach 
Sixty executives completed LEA's and were assigned to two groups. One group (N=30) had high overall leadership scores on the LEA dimensions. The other group (N =30) had low scores. To test for significant differences between the groups, t-tests were calculated. Each of these groups also completed the PIL test. Pearson product-moment correlations were calculated for the association between the LEA dimensions and the PIL score. 
Significant Differences 
Significant differences were found between the high and low LEA groups (p<.05). High and low LEA groups also yielded significant differences on the PIL test (p<.05). Significant correlations (p<.01) were found between the LEA scores and the PIL scores of the high LEA group (but not the low LEA group). The significant correlations found in the 13 dimensions of leadership are summarized by the roles of: Creating A Vision, Developing A Followership, and Implementing The Vision. Correlations were not significant for the remaining roles and dimensions (i.e., Following Through, Leadership, Style, and Tearn Playing). 
Purpose, Leadership, And Meaning 
The results of this research suggest a relationship between perceived purpose and certain critical aspects of leadership. Those who perceive themselves as leaders are characterized by a greater sense of purpose than those whose leadership perception is not as strong. 
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The results also suggest a linkage between the concepts of transformational leadership, much discussed in leadership research3, and the logotherapeutic concept of purpose and meaning. Transformational leaders are those who change the very assumptions we have regarding our work and the world in which we live. They are characterized by strong visioning skills and the tenacity and courage to empower others to work toward a vision which is adopted by their followership. Transformative leaders are contrasted with transactional ones, to whom the process and products of management are more important than those of change and creation. 
The idea that meaning and purpose underlie transformational leadership is intuitive. The present research points to a correlation between executives strong in their perception of their transformational leadership skills, and their perceived purpose in life. The gift of these leaders is to be able to actualize that purpose and its foundational meaning to those who follow them through the common goals which characterize effectively led organizations. These leaders give us the chance to define our own meanings through the medium of organizational life. 
For business, this extended definition has some significance. We teach leadership as if it were a group of behaviors which only need to be modeled correctly to be successful. Without the catalyst of purpose and meaning, however, and the basic skills to communicate that purpose and meaning to others, leadership is ineffective at worst, or transactional at best. The empirical relationship found between purpose and leadership replicates previous work in logotherapy research. Humberger5'6 and Kets de Vries7 have sensitized us to the impact of executive psychology on overall organizational effectiveness. New techniques based on logophilosophy need to be added to our management curricula, and we need to squarely face some of business's reluctance to deal with the noetic aspects of our working lives. 
Today, as In other historical epochs, we need our leaders badly. In fact, we might say we all need to be leaders, each in whatever way is appropriate for our lives and our individual destiny. Leadership is not managership, chemistry, or charisma; it is stewardship, courage, personal sacrifice, and the ability to clarify meaning for ourselves and others. 
ROBERT A. LEVIT, PH.D. {19116 Jericho Drive, Gaithersburg, Maryland 20879, U.S.A.] is Director of Human Resource Development for MCI Communications in Washington, D.C. Dr. Levit's work includes both training and clinical organizational psychology. 
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References 
1. 
2. 
3. 4. 
5. 6. 7. 
8. 
Bass, B. (1985). Leadership and Performance Beyond Expectations. NY: The Free Press. Bass, B. (1990). Bass & Stogdifl's Handbook of Leadership(3rd ed.). NY: The Free Press. Clark, K., & Clark, M. (Eds.). (1990). Measures of Leadership. Greensboro: Center for Creative Leadership. Crumbaugh, J., & Maholick, L. (1981). Manual of Instructions for the Purpose In Life Test. Murfreesboro: Psychometric Affiliates. Humbarger, F. (1981). The executive in an age of alienation, International Forum for Logotherapy, 4, 35-44. Humbarger, F. (1985). Logotherapy's impact on counseling the executive. International Forum for Logotherapy, B, 47-53. Kets de Vries, M. (1991 ). Organization On the Couch: Clinical Perspectives On Organizational Behavior and Change.San 
Francisco: Jossey-Bass. Mahoney, J. (1987). Leadership Effectiveness Analysis: Facilitator's Guide. Portland, ME: Management Research Group. 

Viktor E. Frankl, M.D., PH.D.: Founder of Logotherapy, Professor of Neurology and Psychiatry at the University of Vienna, author of 30 books, including Man's Search for Meaning. published in numerous languages. 
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The International Forum for Logotherapy, 1992, 15, 76-79. 
SUFFERING IN A NURSING HOME: LOSSES OF THE HUMAN SPIRIT 
Patricia L. Starck 
Viktor Frankl described suffering as an ineradicable part of the human condition, touching upon the various dimensions of human beings, namely: physical, social, and spiritual. 1 He drew an analogy between suffering and the behavior of gas. If a certain quantity of gas is pumped into an empty chamber, it will fill the chamber completely and evenly no matter how big the chamber. Frankl also viewed suffering as a test of strength and courage. He postulated that meaning can be found in unavoidable suffering, and logotherapy can assist people to find the meaning. 
Becoming a resident of a nursing home can be one of life's most difficult transitions and usually is stressful for the individual and for his/her family. The adjustment period, which may last up to several months, is likely to be an intensive suffering experience. The nursing home staff faces the challenge of assisting residents to cope with suffering. The staff is the primary caregiver to respond to suffering, yet is usually under-trained to cope with such a challenge. Indeed, the staff members themselves suffer from this thankless and endless job. Many become depressed from their work environment and become negligent of their own needs. In order to cope, staff will have to develop a system of prioritizing the suffering needs of those in their care. 
Nursing Home Study 
In an ethnographic study, conducted in 1990, of how suffering is managed in a nursing home it became clear that suffering can be operationally defined as loss.2 It became equally clear that loss is experienced in each human dimension, with great losses occurring in the spiritual dimension. 
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The study was conducted in a 180-bed nursing home in the Southwest United States. Using existential social theory, it examined the interaction between staff and residents in managing the work related to suffering. Methods included observation and individual/group interviews with staff. 
In the study, losses of this patient population fell into four categories: 
a) physiological, b) psychosocial, c) economic, and d) losses of the human spirit. Physiological losses included vision, hearing, mobility, energy, endurance, resources, control over bodily functions, and memory. Psychosocial losses encompassed activities of family, friends, and community. Economic losses were revealed in a pervasive fear among nursing home residents that they would outlive their resources. Any renovation in the nursing home created fear that the resident cost would go up beyond affordable levels. Residents were concerned not only about the loss of their home and material possessions but also about having sufficient resources to live and to take care of burial expenses. 
Losses of the human spirit were most striking in the residents' loss of autonomy, authority, control, freedom of choice, sense of gender, and privacy. Furthermore, residents expressed feelings of low self-worth, uselessness, and loss of sense of purpose in life. They even lost the basic dignity of being given accurate and truthful information, as many residents were "protected" from any news that might upset them. 
Having a meaning in life is said by Frankl to be the most primary human aspect, and loss of it creates the deepest despair. 1 Nursing homes do not provide opportunities for residents to contribute much that is useful; usually, not even to make their own beds, even if physically capable. 
In the study, staff acknowledged that all residents suffer losses. Staff further assessed the residents by degree of suffering, and distinctions were made between "true sufferers" (i.e., those deemed to be really hurting) vs. "attention seekers." Residents sought attention either overtly or covertly. The overt ones were labeled complainers. They were considered loud, assertive, and demanding. The staff generally responded by placating, cajoling, or ignoring, while attempting to do what they thought was best for the resident. The covert complainers were considered quiet, passive, and nonconfrontational. However, the covert complainers often sought help from outside, usually by complaining to family members. One resident called 911 for help. This type of action really annoyed the staff members, and they were likely to respond with a negative sanction, berating the resident for this behavior. 
The "true sufferers," as labeled by the staff, were those who suffered in silence, who were meek and nondemanding. Often they were residents with 
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no family support. To these residents, staff exhibited affectionate behaviors. They bought them gifts and took on the role of a family member. They also tried to protect these residents from unpleasant truths, such as being abandoned by their families. 
The Role of Logotherapy 
The staff in this study did not generally recognize needs of the human spirit, nor did they hold a concept of suffering as postulated by Frankl. Care in nursing homes needs to be improved and logotherapy has much to offer. Unfortunately, the lack of understanding about the spiritual dimension of human beings causes many caretakers to fail to be supportive in suffering. 
Logotherapy holds the potential to improve care in nursing homes for a growing population of the elderly. Improvements may include: 
1) Training programs for nursing home staff to promote understanding of all dimensions of the human being, using Frankl's position that the primary human motivation is to seek meaning in life. A six-hour training session is recommended including: 
a) 1 hour of lecture on the tenets of logotherapy, including film; 
b) 1 hour of discussion of Man's Search for Meaning; 
c) 
1 hour of staff taking designated logotherapy tests: PIL, SONG, MIST, or Logotest; 

d) 
1 hour of seminar discussing life-meaning in self and others; 

e) 
1 hour of seminar discussing suffering (loss) experienced by nursing home residents within Frankl's framework of human suffering; 

f) 
1 hour for final exam. This training should be conducted during the orientation of employees new to nursing home care. The employees should be encouraged to read Man's Search for Meaning and copies made available. Employees should be reassured that their scores on the PIL, SONG, MIST, or Logotest will not have any effect on their employment. If problems are evident, these staff members should receive follow-up individually. The final exam should test for basic understanding of the concepts. A certificate of completing "Basic Logotherapy for Nursing Home Care" should be issued upon completion of the six-hour training program. 

2) 
A logotherapeutic program for residents and their families for the initial adjustment period. It is recommended that this logotherapeutic resident/family admissions program consist of the following: 

a) 
A pre-admission conference on the transition, anxieties/fears, and expected benefits. Socratic dialogue, paradoxical intention, and dereflection can be used. 

b) 
One-hour-long group meetings each week for: new residents (include some on-going residents); families of new residents (include also some families of on-going residents); and new residents plus their families (include some on-going residents plus families). Discuss problems being experienced, feelings of loss, guilt, etc. by new residents and families. Encourage support from on-going residents and families who are adjusted. 

3) 
Programs that train staff how to help residents meet the needs of their human spirit. A four-hour session is recommended, in a group process format, wherein staff: 

a) 
Identify ways that current practices encourage loss of the following: autonomy, authority, control, freedom of choice, sense of gender, privacy, self-esteem, usefulness, sense of purpose in life, accurate information. (Write answers on large sheets of paper and post around the room.) 

b) 
Identify changes that could be made to enhance the human spirit in each of the areas listed above. (Post these sheets and distribute the ideas to administration and staff. If policy changes are needed, follow-up with the administrator.) 


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PATRICIA L. STARCK, D.S.N., R.N. is professor and dean, School of Nursing, The University of Texas, Health Science Center, Houston, Texas 77030, USA, and Director of the Center for Logotherapy, 7505 Fannin Street, Suite 510, Houston, TX 77054-1913. 
References 
1. Frankl, V. E. (1959). Man's search for meaning: An introduction to logotherapy. NY: Beacon Press. 
2. Starck, P. L. (1992). Suffering management in a nursing home: An ethnographic study. In P. L. Starck & J. P. McGovern (Eds.), The hidden dimension of illness: Human suffering. National League for Nursing Publishing Co. 
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The International Forum for Logotherapy, 1992, 15, 80-82. 
THE MEANING WALK: A LOGOTHERAPY RETREAT EXPERIENCE 
Florence I. Ernzen 
Viktor Frankl has written of the rock climber who is asked while experiencing a sunrise or a sunset after an arduous climb, "does life have meaning?" Of course, the climber responds from the core of his/her being with a resounding "yes." Experiences in nature help us to explore our values and discover insights that enrich our lives. We find affirmation and direction as well as renewal. 

In October, 1991, participants at a Logotherapy retreat were invited to go on a Meaning Walk. This concept evolved from the work of Jim Rosemergy, author and minister. 
On a Meaning Walk, each person is given a Meaning Walk Script to follow. They are encouraged to walk alone. The script includes instructions plus thoughts that center attention. For example, the opening thought is, "Life, I seek a deeper understanding of your innermost meanings for me." The participant is invited to notice what is far away and what is close; look up at the sky and down at the earth. The script asks what are you feeling? What impresses you most about your surroundings? 
The script continues with centering thoughts and instructions. The instructions include walking, jogging, moving like a leaf in the wind, and listening to sounds. Eventually the "walker" is instructed to find a place apart and sit quietly. More instructions and focusing thoughts provide guidance. Everyone is encouraged to bring something back to the assembly area that is symbolic of the inner experience on the walk. Upon returning to the assembly area, a final set of instructions encourages all participants to create a poem, letter, song or drawing of some awareness they had on their walk. 
The retreat was held at an old Benedictine Sisters Mother House and College in Atchinson, Kansas. There were fields and orchards and a lovely old graveyard where the Sisters are buried. Many people were influenced by the presence of the graveyard and the old buildings. Their drawings included the 
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gravestones. One person's thoughts were: "Despite the inevitability of physical death, life is best lived in an uphill fashion. Death may bring peace and is best not dreaded, but can give impetus to life and its forward movement. We cannot know what lies beyond death for certain, but as the squirrel does not know what lies past winter, it keeps busy and we should, too." 
Another person responded with poetry... 
Bright sunshine from above The wind-driven clouds Soft green earth beneath my feet Cold, cold wind upon my cheek Yellow, green--cold, warm Dizzy--I stand and contemplate-Tombstone--row on row almost nod and bend to me I genuflect, yet pass on-Giant oak, valley secluded Showing the scars of life--Proud Exalted arms-All of life inside me-Outside of me too The gold of walnut leaves The green of pine Sweetness of clover Balm of yew Brick upon brick silhouette against the sky Like Christmas card of olden times Strains of Bethlehem Contrast--paradox Decay of bark and limb Unopened cone--the almost new green Give hope I hug the oak--sturdier than I No matter if the leaves are torn Beauty remains--hope unfolds The brilliance of dandelions, enough Itself to propel me eons hence. 
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Another participant wrote an exuberant letter of appreciation to herself. 
Another walker rejoiced in being alone on her walk and at the same time revelled in knowing we are all taking the journey together. Many participants felt a deep connection with all of life: the darkness and the light, beginnings and endings, decay and renewal. 
As logotherapists we encourage people to find their own unique meanings in each situation of life. The Meaning Walk was an opportunity for retreatants to be alone to discover in a natural setting the thoughts from their own intuitive awareness. In the sharing of our insights we discovered our connection and reconfirmed how fundamental our search for meaning really is. 
FLORENCE ERNZEN, MSW, Dip/ornate in Logotherapy, is a School Social Worker in Wyandotte, Michigan, Logotherapy Retreat Leader and Trainer. A copy of the Meaning Walk Script can be requested from her at 816 Ardmore Drive, Dearborn Heights, Michigan 48127, USA. 
MALONE: A CONVERSATION WITH VIKTOR FRANKL 
Viktor Frankl... Founder of Logotherapy, Professor of Neurology and Psychiatry at the University of Vienna, author of 30 books, including Man's Search for Meaning. In his 86th year, Dr. Frankl talks passionately and candidly about his remarkable life to public television's Michael Malone. 
Michael Malone...well known for his interview program, Malone, widely syndicated on U. S. public television. With roots in investigative journalism, he has authored several books, including the book that provided the basis for the PBS series, Silicon Valley Trilogy. Join author and host Michael Malone for a conversation with one of the most outstanding contributors to psychological thought in the last 50 years. 
This 30 minute videotape is available from THE VIKTOR FRANKL INSTITUTE OF LOGOTHERAPY P. 0. Box 2852, Saratoga, California 95070 USA 
$50.00 + $4.50 postage (California residents add $4.25 tax) 
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The International Forum For Logotherapy, 1992, 15, 83-85. 
LUCY'S STORY: A LOGOTHERAPY ENCOUNTER 
Ann G. Westermann 
I came upon Lucy during the holidays at an open-house party. She sat in a dark room, all alone, crying. Although I had met her before as a friend of the hostess, I had felt Lucy would be hard to get to know because she seemed to have an armor of protective coating about her. Now her heart-rending sobs drew me to her. When I asked, "Lucy, what is it?" she put me off by saying, " I can't talk about it!" Nevertheless, I felt I ought to stay with her. As it turned out I would do the most intensive logotherapy I had ever done--while a party was in progress downstairs. 
After sining with her quietly for a while, I began a Socratic Dialogue by saying, "Lucy, you seem so sad, so despondent...! wonder, what could have caused you such pain?" Bit by bit, between sobs and tears, Lucy haltingly told me about the cause of her anguish, her shame, and guilt. 
As a young girl she was a devout Catholic and wanted to be a nun. She entered the convent after high school. Her family was glad. After five years in the novitiate she found she did not fit, nor did it give her the peace and joy she had hoped for. Coming out of the convent was traumatic, especially since she didn't have any marketable skills to support herself. Going back home was out of the question. She eked out a living through door-todoor sales. 
In time, she met a man who she thought was "the love of her life." They lived together. Lucy was looking forward to a future with him, dreaming of marriage and family. When she found she was pregnant, he couldn't face the responsibility and not only abandoned her, but as she put it,..."ran away with his mistress." 
She was shocked to the core, destitute, and ill. Her family treated her as "the scarlet woman" who brought nothing but disgrace upon them. They hid 
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her existence (and her pregnancy) as much as possible. "As the time of birth approached I went to a Catholic hospital," she said, "where they gave medical assistance to girls like me, but kept me in a separate unit in total isolation without any relief for pain during three long days in labor. No one came to visit me...l was so scared...My body was racked with contractions that went on and on...Worst of all, I felt like a moral leper and a social outcast." 
Following the difficult delivery she placed the baby, a little boy, for adoption--wanting a better life for him than she was able to offer. She left the hospital and tried to pick up the pieces of her shattered life. At first she plotted to kill the father of her child and his mistress. Gradually the grief over the loss of her baby consumed all energy for revenge. 
''The holidays are the worst time for me, second only to his birthday," sighed Lucy. "Mothers have so much fun getting Christmas gifts for their children, I can't even tell anyone that I had a child. Never even made Christmas cookies for him..." 
Here I began to probe in the hope of effecting an attitudinal change. "Have you ever made a birthday cake to commemorate the occasion?" 
Lucy: "A b...birth...birthday cake? I never thought of it. But I look at his birth certificate just to acknowledge that he exists! No one ever saw it. No one ever wanted to see it." She cries uncontrollably. 
Ann: "Does he have a name?" 
Lucy: "I named him George, little George." 
Ann: "Lucy, how old will little George be on his next birthday?" 
Lucy: "He'll be 18. Why,...he's nearly grown." 
Ann: "Lucy, how would you like to plan a birthday party for George? Kind of a "Coming of Age Party" where you tell him everything that's in your heart concerning him?" 
Lucy: "Who would come?" 
Ann: "I'd be honored to receive an invitation to such a party." 
Lucy: "You would? You don't think I'm a degenerate, totally worthless woman?" Ann: "No, Lucy!" I resolutely shake my head. Then I witness the most cathartic experience I have ever seen as Lucy 
releases years and years of pent-up grief, anguish, repressed emotions over the loss of a child she loved and couldn't even acknowledge publicly. Her deep painful secret was out and she had neither been judged nor condemned. 
Spent from violent sobbing she continues to cry softly while I talk to her gently about her deep love for her child. I point out her courage in living through the pregnancy after she was abandoned. 
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Lucy: ''That's right! I still could have had an abortion. In 20 minutes that life would have been snuffed out. My conscience wouldn't let me do that. Something made me carry him to term." 
I tell her that she made a self-transcending choice in spite of great obstacles and that the time for celebrating that choice had come; time for acknowledging the defiant power of the spirit that had brought her so far. 
Lucy: "Yeah...You know, after I found better work, mostly clerical, I went to night school. Eventually I earned a teaching certificate. But I stayed away from schools in fear. What if one of the kids turned out to be George?" 
Since I know of Lucy's religious background, we talk about the sustaining assistance of God (grace) operative in her life. How it could help her transform this fear into anticipatory excitement. 
She begins to see herself as a woman of courage who has suffered much and has grown strong. A lavage of the soul seems to have occurred-her shame and guilt gone. She feels absolved, freed from the burden of the past. 
Ann: "Lucy, what if one of the students were George?" Lucy: "I'd want to be the best teacher he ever had!", she says enthusiastically. A month later I heard that Lucy had begun to work in a school for the arts. Her students will be young people of all ages. 
Also I look forward to an invitation to George's "Coming of Age Party." I will want to see his birth certificate and I plan to bring flowers to his mother-on behalf of George--in appreciation of her love and sacrifice. 
ANN G. WESTERMANN {133 Condor Ct., St. Charles, MO 63303, USA] is an ordained, ecumenical minister primarily engaged in therapy work of a spiritual nature, leading growth groups, conducting special worship services, and lecturing in St. Louis, Missouri. She recently completed training requirements for Dip/ornate Certification in Logotherapy. 
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The International Forum For Logotherapy, 1992, 15, 86-89. 
ASSESSING THE LOGOTHERAPEUTIC VALUE OF 12-STEP THERAPY 
John M. Majer 
One cannot deny the theoretical similarity between logotherapy and 12step programs, as pointed out by Holmes.4·P·35 The following study was conducted to support the logotherapeutic value of treating chemically dependent persons by 12-step fellowships such as Alcoholics Anonymous (A.A.) and Narcotics Anonymous (N.A.). 

Subjects and Treatment 
The subjects who volunteered for this study were 29 clients from Raft House, Inc., a nonprofit, long-term (12-24 months) residential facility for chemical dependency. All clients were screened by the Director of Treatment (a recovering alcoholic of 30 years in A.A.), and had a long-standing history of chemical dependency despite prior treatment attempts. 
The study treatment consisted of random urinalysis and blood alcohol level testing, mandatory attendance of at least seven 12-step fellowship meetings, group counseling, two mandatory house meetings per week, and either full-time employment or full-time educational/vocational training. Treatment also included mandatory weekly one-hour sessions with a counselor. The counselors' qualifications consisted of a keen understanding of 12-step philosophy. All counselors were either recovering "alcoholics" or "addicts" who attended A.A. or N.A. meetings regularly and had abstained from the use of mood-altering chemicals for at least two years. Only 2 out of 1O counselors had four-year college degrees. As treatment, 12-step fellowship was applied instead of psychological or traditional counseling. 
About 15% of all selected clients successfully completed the 12-24 month program. Most clients were discharged early either for not complying 
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with the above mandates or tor not complying with house rules for residential living. 
Materials 
Subjects were given the following logotests in respective order: Purpose-in-Life Test (PIL)3, Seeking-of-Noetic-Goals (SONG)2, Meaning-inSuffering Test (MIST)8, and Life Purpose Questionnaire (LPQ)5. They were told that there were no time limits, that their responses would not affect their status as a client, and that their results would not be disclosed until their departure. Subjects were tested in small groups and the average time tor completing the battery was about an hour. 
Design and Results 
The study compared test scores between two groups during an 18-24 month period. Significant score differences between Group Y (clients who were at the beginning of treatment; 8 female, 13 male) and Group O (clients who were near conclusion of treatment; 2 female, 6 male) showed that 12-step therapy and a drug-free life was correlated with clients' meaningful living. 
GROUP  V  GROUP 0  
(N=21)  (N=8)  t  
_M_  _fill  _M_  _§Q_  Value  

PIL 90.05 17.01 105.13 9.34 2.36** SONG 89.19 13.79 78.63 15.02 1.80* MIST 92.67 14.06 103.00 6.32 1.99* LPQ 10.10 4.55 15.00 1.85 2.93*** DAYS 38.19 6.33 522.75 115.51 AGE 33.90 5.36 32.00 5.95 N.S. 
(d.f. = 27; *** = p<.01, ** = p<.05, * = p<.10). 
The data demonstrate a relationship between the amount (days) of 12step therapy and the extent of meaning and purpose in life. The longer the commitment to A.A. or N.A., the greater the likelihood to find meaning in life. PIL and LPQ score differences between groups showed an increase in one's life purpose during the treatment. SONG score differences suggested that motivation for meaning decreased as the amount of time in treatment increased. Finally, MIST score differences between groups indicated that the 
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extent of finding meaning in unavoidable suffering increased as treatment progressed. A moderately positive correlation between Group O scores on amount (days) of treatment and MIST scores supports this finding (Pearson 
r = .55). 
Discussion 
Overall, it would appear that clients in Group O were empowered to find meaning (thus the increased PIL and LPQ scores), thereby satisfying their need for such a pursuit (thus the lower SONG scores). Regardless of whether all clients were confronted with unavoidable suffering during therapy, their perception of suffering was likely to be altered in a meaningful way (thus the increased MIST scores). These findings coincide with the notion that logotherapeutic changes in attitude, value awareness, self-concept, and behavior occurred as a result of A.A. or N.A. This result would be predicted because 12-step therapy and logotherapy both address the human spiritual dimension. Additional research, including larger groups and control groups, is needed to further assess this hypothesis. 
Half of Group O were A.A. members, the other half were N.A. members. All were participating in meetings regularly, maintaining relationships with members outside of meetings, working with a sponsor, engaging in formal 12-step service work, reading A.A. or N.A. literature, and remaining chemically abstinent. I would argue, in response to Peyror1·P· 1520 that 12-step fellowships do serve as a therapeutic modality because participation stengthens selftranscendency. 
I propose some ideas for those who treat chemically dependent persons. First, counselors and therapists should be aware that 12-step fellowships such as A.A. and N.A. do provide a therapeutic service. 
Second, psychological and educational approaches may result in hyperreflection on psychological and mental issues, thereby lowering attention that could be focused on the noogenic dimension. These approaches may prevent the client from actually experiencing the 12-step method because sheltered learning impedes active 12-step participation. 
Perhaps for this reason the integration of psychological and educational approaches with the 12-step approach leads to confusion in ex-patients who end treatment and then "get lost" in their follow-up treatment (usually with A.A. or N.A.). Some of the main 12-step concepts are "powerlessness," "sponsorship," "recovery vs. abstinence," "power greater than ourselves," "12-step service commitment," "steps and traditions," "home group," and "care of God as we understood Him." These concepts offer meaning to the recovering 
BB 
"addict" and "alcoholic." Therefore I recommend that counselors and therapists visit a few 12-step fellowships, ask questions, and read these fellowships' literature.1'6 
JOHN M. MAJER [50 Boone Trail, Severna Park, Maryland 21146 U.S.A.] is a graduate student in Counseling Psychology at Bowie State University, Bowie, 
Maryland. 
References 
1. 2. 
3. 
4. 
5. 
6. 
7. 
8. 
Alcoholics anonymous. Alcoholics Anonymous (3rd ed.). NY: 
A.A. World Services, Inc., 1976. Crumbaugh, J. C. (1977). The Seeking of Noetic Goals test (SONG): A complementary scale to the Purpose in Life test (PIL). Journal of Clinical Psychology, 33, 900-907. Crumbaugh, J.C. & Maholic L. (1969). Manual of Instructions for the Purpose in Life Test. Murfreesboro, TN: Psychomatic Affiliates. Holmes, R. M. (1991). Alcoholics anonymous as group therapy. International Forum for Logotherapy, 14, 36-41. Hutzell, R. R. (1989). Life Purpose Questionnaire. Berkeley, CA: Institute of Logotherapy Press. Narcotics Anonymous. Narcotics anonymous: Basic text (3rd ed., revised). Van Nuys: World Services Office, 1986. Peyrot, M. (1985). Narcotics anonymous: Its history, structure, and approach. The International Journal of the Addictions, 20, 1509-1522. Starck, P. (1983). Patients' perceptions of the meaning of suffering. International Forum for Logotherapy, 6, 110-116. 
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The International Forum For Logotherapy, 1992, 15, 90-98. 
MEANING AND GOALS IN THE CHRONICALLY ILL 
Elisabeth Lukas 
From puberty, when the personal self takes control of itself, each of us makes blueprints and plans for our lives. These plans are changed again and again in a dynamic process, permeated with ideals, reconciled with realities, enriched with hopes, and rebuilt on buried illusions. Despite these ups and downs, a constant line can usually be seen. 

Our plans for the future reveal as much about us as does our past. Although there often is a great discrepancy between what we intend to do and what we have done, this discrepancy reveals characteristic things about us. Accordingly, in order to understand who their patients are at present, psychologists should draw their conclusions not only from what their patients have experienced and how they developed, but also from the patients' plans. Of course, the past already has become certainty. Nothing about it can be altered or changed. The future, on the other hand, is uncertain. Corrections are still possible and goals can be changed. Nothing may turn out as we believe it will. If one were to compare our past life with the pages of a diary in which no erasures or rewrites are permitted, then our future plans could be compared with the outline of an essay for which an unknown number of empty sheets are available with the condition that the pen not be held by our hand alone. 
These considerations have relevance to Frankl's concept of meaning: 
''The human being is comparable to a pilot who is 'guided' blind to an airport on a foggy night. Only the given glide path leads the pilot to his destination. In the same way all people have their own unique individual pre-drawn path in every situation in life, on which they can reach their most individual possibilities."1' P·59 
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The Meaningful Path 
There is no mention of "predestination," because the pilot need not submissively follow the invisible glide path which guides safely to the runway. We are free to steer, to veer off, even to switch off the engines and go straight down (as is every suicide victim). However, if we wish to arrive where we ought to arrive, where conscience and responsibility direct us, where it is most salutary to us and those entrusted to us, then we must commit ourselves in freedom to this designated path, for this is the most meaningful path for us. It is the most meaningful path for every person, entrusted with unique tasks which only we can and ought to fulfill. Everyone is awaited by something in particular which only this person can fulfill. There is something intended for each of us in this world. Just as a safe spot on earth awaits every aircraft, wherever it takes off, and a dear friend or personal task awaits each passenger at the destination, every person has a great love or a great work waiting. 
We set our life goals ourselves. How we do this, and which goals we set, depends on internal factors such as mental state or character structure. But the meaning of life enters our lives from without, is designated to us, and is a guiding ray that leads us to the highest realization of our unique existence. 
This view of meaning offers a comforting perspective. Consider the question: Is a glide path conceivable that would guide a jumbo jet to a tiny airport with a runway far too short? Is this not unimaginable? It would be senseless to guide an aircraft to the wrong airport. In the same way there can be no task intended for us for which we do not have the necessary time, strength, and talent. If a meaning in life really awaits us, then everything that we require for its fulfillment must already lie, so to speak, in our cradle. And if an individual meaning of life awaits everyone, then something different must lie ready in each cradle--a different supply of abilities, opportunities, health, and time. A plane near its destination needs very little fuel; a plane whose destination lies high in the mountains needs de-icing equipment, etc. All of this must be taken into account beforehand, otherwise the plane is not cleared for take-off. We, too, cannot be cleared for take-off into life with a designated path which we cannot travel unless we postulate a cynical and sadistic image of our Higher Power, which I will not assume here. 
In psychotherapeutic practice, patients who have adopted this view can succeed in becoming calm and composed with respect to their plans. A teacher who was in counseling with me drove to a principals' conference saying to herself, "If it is I who am supposed to represent the interests of our 
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school, then, with proper preparation, the necessary energy and skill will come to me. And if the necessary energy and skill fail to come to me, then this task is not my task, but is intended for someone else, and I will gladly withdraw from it. After all, other people want to be good for something too." Six months before this, the same teacher would have been terrified of participating in the conference and of suffering some lapse at the conference. 
A further example is a chronically ill patient of mine who had long hesitated to begin a course in social work. The question that had always held her back was, "Ill as I am, will it be worth doing this course?" After our counseling, she decided to begin immediately and not waste any more thoughts on whether she would live long enough to work as a social worker. She had understood: If this was the meaning of life awaiting her, then hours and days would be there for this activity as a social worker. If the necessary hours and days were not there in the end, this would mean that no activity in social work was awaiting her, but that the path laid out for her would find meaning and fulfillment in her training, full of interest and joy. 
To rise to this inner calm and composure it is necessary, however, to take to heart two aspects of this point of view: 
1) Even if I can be sure that I possess the power to travel the path designated for me, I cannot succumb to the error of thinking that the path can be travelled without effort. The meaning of life can long remain hidden, and does not land in our laps; it must be sought and conquered. Only when I contribute my share of effort, commitment, practice, and of course take care of my health and fight any illness, only then will that which is intended for me be realized. Without my efforts it remains purely potential, a good path that could have been travelled. 
2) That which is not present in me as potential is not mine--this bitter truth must be accepted. How bitter it is depends on my attitude. Some people protest against blocked paths, but who knows how steep these paths would be? Drivers complain about closed mountain passes in winter although this is done only for their protection! Similarly, a particular task could be too difficult for us and is therefore not intended for us. Let us see it therefore as a relief that our days and strength are limited. Otherwise there would be so much more in the world for us to concern ourselves with, to worry about, to take on. 
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Life Goals 
Life goals are chosen by the individual, they bear the unique stamp of their designer. And they are created, despite periodic adjustments, with relatively high consistency. The pattern according to which we forge our life plans changes much less often that the plans themselves. As said before, all life goals and plans are uncertain, as part of the future, mere outlines of diary pages still unwritten, the contents of which are not in our hands alone. 
Now let us try to build a bridge between the meaning of life as the guiding ray which invisibly but perceptibly pervades our lives, and the personal life goals which are visible in acts of will and in wishes, but of which we can also lose sight. The bridge consists of the awareness that the nearer our life goals approach the life meaning which is present from the beginning, the more certainly they will be achieved. This is expressed in the following formula: The more meaningful a life plan, the more probable is its completion. 
What argument comprises the main support of this bridge? Simply: Since all our internal capabilities and external opportunities for realizing our plans are "placed in our cradle" in order to be fulfilled by us, we are optimally equipped to aim at goals within the realm of that which awaits us, and we are ill equipped to pursue aims which lie beyond this. Of course, we can set goals which do not correspond to the unique meaning of our unique existence, but when we reach for what is not meant for us, we must be prepared to fail. The pilot who leaves the glide path assigned to the route, and flies in darkness and fog to a distant airport, increases the uncertainty of a safe landing. 
The Healthy and the Sick 
All these considerations are true for the healthy and the sick. The difference is not great, for to put it bluntly, both are condemned to die. Both have limitations of strength and time. Perhaps the only difference is that the healthy can always become sick, but the sick cannot always become healthy-so a step toward death is possible under all circumstances, but a step toward life is possible only under certain conditions. Just as the past is more "certain" than the future, death is more "certain" than life--a fact far more apparent to the sick than to the healthy. 
Whether their goals must therefore be of a different nature must be investigated. Since the healthy have no guarantee of an unlimited life, they cannot build their life plans on greater security than the sick. The certainty with which a plan can be put into action is based not on a presently stable constitution, which can be reversed at any time, but on the congruency of our plans with the "plan which is meant for us." For this reason we must ask: Is 
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it possible that something different awaits chronically and terminally ill people? Is it possible that something essentially different is intended for them; a meaning of life of a special quality? For only then should their personal goals be different from those of the healthy. 
This question is not easy to answer in theory. Here are two examples from practice. 
One of my patients had a bad marriage. He came to me to talk or, more precisely, to complain. For two hours he grumbled about his wife. Since I always like to hear the other side, we arranged an appointment for his wife. Before this could take place, however, the couple had a road accident in which the woman was thrown from the car and seriously injured. She sustained brain damage and remained paralyzed on one side of her body after spending months in a hospital. Her husband, who worked, placed her in a good nursing home and maintained regular contact with her. He visited her every second day, caressed her, read to her, fed her, washed her, and took her out in her wheelchair. He often brooded, feeling a mixture of regret and guilt about his earlier married life. Then he came to me because he couldn't break loose from this brooding. "Why did my wife and I get on so badly?" he asked me. "Why did we bicker constantly about trivial things?" 
How can one reply to this? It's the old story of the flowers one should give during life, because their fragrance is wasted on the grave. But in this case life was still present, even if it was handicapped, and the man was giving flowers, both literally and figuratively, in caring for the disabled woman. This deserved emphasis. Thus I spoke of the "flowers of the present." 
"I'd like you to consider one thing," I began. "If your marriage had been happy, then what you are now doing for your sick wife would have been a matter of course. It would have been the logical consequence of a happy human relationship. However, what you are doing is something extraordinary, an extraordinary achievement. For now you could easily take revenge for the many small disagreements with your wife. You could make this human being, now helpless, atone for any nagging and quarrels with which she may have made life hard for you. But you do not do this. You fulfill your duty as a husband, regardless of what once passed between you. This demonstrates inner greatness. And you see, you could never have put to the test this inner greatness which you possess if things had been different. You would not have known of its existence. You would never have discovered what tremendous ethical potential was dormant in you. Only in this constellation: bad marriage, accident, permanent helplessness, and dependency of your wife on you, and 
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loving care by you for your wife, only in this constellation has something in you been revealed of which you can be proud." 
The man listened, deeply moved. When I stopped speaking, he moved closer to me and whispered his response as if it were a confession. "To be honest," he whispered, "it is her inner greatness which makes that possible. She bears her fate calmly and patiently. Every time I walk through the door, she smiles radiantly. She never takes out a bad mood on me. I have no idea how she manages it, but she shames me so much with her attitude that I am changing from day to day, following her example. The ethical potential of which you speak leaps from her to me like a spark, I can feel it." 
A second example concerns a twelve-year-old boy who had suffered from leukemia from his ninth year. His father was a physician, and I met him at a medical convention where we got to talking. I asked him if it was particularly difficult as a doctor to have a chronically ill child for whom he could do little more than relieve his symptoms while watching the illness progressively worsen. 
The doctor thought about this. "You know," he said finally, "sometimes it seems to me that we have gained more through our son than we have lost through his illness." This statement fascinated me and I asked him to expand on these thoughts. He then told me that his wife had been depressed for years. Since their son's tenth birthday, however, she had been healthy. What had happened? She had asked the boy what he wanted for his birthday and he had replied: "A happy mommy!" Wringing her hands she had sobbed: "How can I be happy when you are ill?", to which the boy replied: "But mommy, if I can live with my leukemia, then so can you. Just accept my illness as you accept me." Obviously the mother had thought this over and had fulfilled her son's birthday wish. 
But that was not all, the doctor continued. The boy's siblings and the children in the neighborhood had also profited. They had become more sensible and mature through contact with his son. His son had, for example, given a nearly new football, which he couldn't use, to a child who had been ostracized by the other children because he came from a disadvantaged background. Since then this child had risen in the group ranking by several steps and was tolerated and even liked. They had learned to help the weak instead of laughing at them. "You have mentioned your wife and the children who, as healthy people, have practically been taught by your sick son," I said, spinning the thread further. "How about you? Have you received any insight from your son?" "I?", the doctor asked, at a loss for words. "I have received the most. I have rediscovered prayer." 
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The Chances for the Chronically Ill 
These two examples are not exceptions. They stand with many others. What is reflected here? What can we conclude? Chronically ill people have a greater opportunity to exercise an "instructively converting influence" on those in their environment. This sounds remarkable, but corresponds to the facts. The word of those concerned is genuine. The statements from the afflicted are believable. Their suffering grants them a position of trust to which no healthy person can lay claim. If I stood up and announced that one can reconcile oneself to leukemia, I would appear ridiculous. The twelve-year-old son of the doctor was able to proclaim this message with ease. His mother, siblings, the children in the neighborhood, and his father accepted it from him without resistance. If I stood up and announced that life with brain damage, one-sided paralysis, and confinement to a nursing home and a wheelchair, was still worth living, I would be attacked by critics and skeptics. Yet, my patient demonstrated this clearly every day. 
There are perceptions, not to say "wisdoms," that can be conveyed only by certain groups of people because they simply would not be believed of others. And because this is the case, this favored group of people is called upon to use this opportunity that has been placed in their hands for the good of others. It could be a meaning of life assigned to and meant especially for them, for if they do not use this chance, no one else can use it for them. 
Frankl, a survivor of four concentration camps, has spoken out all his life against the theory of the collective guilt of the German people. He gave a now famous speech, the gist of which was: "A Jew must go and confirm that there were both kinds of people under the Nazi regime, decent people and unprincipled people, and that it would be unjust to condemn them all, lock, stock, and barrel. No Aryan has the authorization, so to speak, to proclaim this truth. An Aryan would be accused of trying to smooth over the atrocities of his race. No, a Jew who has suffered cruelly under the Aryan henchmen must go and confirm this. Then the next generation will understand that there are only two "races" of human beings on earth, namely the decent and the unprincipled, and these are present in all peoples and cultures, societies, and nations." 
We often hear similar statements from specialists who work with drug and addiction therapy. Who has the right to demand from alcoholic or heroin addicts that they do without their drugs and bravely endure the withdrawal symptoms? Those who have never been addicted have no conception of the journey through hell they are proposing. A former addict who has been saved and has escaped this very hell is fully entitled to say that the torment of with
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drawal is worthwhile despite everything because outside, beyond the condemnation to eternal dependency, waits the freedom of life with dignity. Those who have been rescued can impart to the addicted the certainty that rescue is possible. 
The Sick-an Inspiration to the Healthy 
Our question was: Could it be that something completely different awaits the sick, especially the chronically and terminally ill--a meaning of life of a special quality? Practice grants us insights into an impressive perspective: Chronically ill people, and these people alone, can bear witness to the mental and spiritual capabilities of human beings under the most difficult conditions. They and their families, who are also in a difficult situation, can testify that acceptance of the inevitable is possible and that peace with the world and with the no61ogical dimension is attainable, even if the illness remains incomprehensible. When they formulate and demonstrate their "Yes to life," their positive model can inspire thousands of healthy people who may despair of life and, when they bear their fate courageously, they may motivate through their example thousands of fearful people who are afraid of life. The chronically ill and their families could be our best teachers, showing the healthy the true values. These values are not performance and success, competence at work, or expensive self-realization at any price, but rather much simpler achievements such as coping with everyday life without grumbling, gratitude for small joys without being embittered by pain, consideration for each other without losing patience, and much more. 
Which way would a society of people, bursting with health and strength, drift if it were not for the sick, the old, and the disabled who caution us to reflect on life's true values? In what monstrous overestimation of itself would humankind land if we did not have guardians of the knowledge of our limitations and defenselessness? Frankl writes about such "miracles" that are usually preceded by a long process of crises and depressions: "Life does not take shape until it has endured the hammer blows of fate under the white heat of suffering." The suffering does not detract from the shape that finally emerges from the hammer blows. On the contrary, it imparts a "halo" to these guardians of humanity. 
Our patients give us a plain hint. The chronically ill are called upon and asked to testify that life is unconditionally worth living, for nobody can testify this as they can. They are called upon and asked to do this in the interest of everyone, the healthy and the sick, the happy and the desperate, for between health and sickness, happiness and need, there are flimsy walls 
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whose collapse no one can predict. That is the special meaning of life for the chronically ill. All goals they may set for themselves will always be within reach insofar as they answer this call. Whether these goals are related to professional or family life, education, activity, friendship, or experience--for every one of these goals the required time and strength will be available to them. They will express, through their attitude and radiance, the truth that a courageous approach in itself has value. For, in the end, what counts in human life is not success and profit, but rather the true values, which are simple but nevertheless real. One does not need a long life to testify to this. 
ELISABETH LUKAS, PH.D. is director of the South German Institute of Logotherapy [SOddeutsches lnstitut fur Logotherapie GmbH, GeschwisterScho/1-Platz 8, D-8080 FDrstenfeldbruck, Germany}. 
References 
1. Frankl, V. (1982). Artliche See/sarge. Verlag Franz Deuticke Wien, 10th Edition. 

Connie Sweeney, PH.D., President of the Mid-America Institute of Logotherapy, with Forum editors Joe Fabry and Bob Hutzell at Loqotherapy: Vision for the Future (Tenth Annual Kansas City Logotherapy Conference) held at Big Lake Resort in Missouri. 
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The International Forum for Logotherapy, 1992, 15, 99-103. 
THE VALUE OF HEALTH 
THE CURRENT DIRECTION OF HEALTH BEHAVIOR RESEARCH 
John E. Stanich 
Health improvements during the past century owe much to public health measures. Since the 1940's, the Western world has moved away from defining health as mere survival, and now views health as the absence or control of disease plus the experience of well-being.1·P-9·20 The themes of today emphasize happiness, social and emotional wellbeing, and quality of life. It is evident that the issues of quality of life, lifestyle, and self-control through free choice are integral parts of health-behavior research. This increasing focus on health-promoting behavior draws together the subjective world of the person (knowledge, decisions, actions) with the objective world (medical facts and others). Singly, each area leaves a void; together, they offer the most promising approach to health-behavior investigation. 
In realization of this, study of the interplay between individual health practices and various measurements of health and well-being is warranted. A look into the boom and subsequent impact of pensioner organizations as well as the amassed literature and media coverage of gerontology provides fertile ground for investigation. This area of study is one example of phenomenological research combined with statistical analysis in the 1990's that is based on subjective health judgments together with sociological and psychological perceptions. Additionally, its intent is to complement the objective world by illuminating factors generally not considered medically relevant. 
Health Promotion 
The fact that the individual is not only a recipient but also an active, deciding being in daily nutrition, alcohol consumption, living habits, to name but a few, is gaining respect at a rapid pace. Gone (or going) in healthbehavior research are the views that we are determined to act only in paths that lie outside of our control. The idea that the individual bears some 
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responsibility for his or her health is foreshadowed in Frankl's logotherapy. The resulting questions are relatively new for the general population (and certainly of great interest to food, nutrition and advertising corporations). For instance, research can focus on preventive activities (prevention of onset, progression, or recurrence), health protection (mainly legal and fiscal controls) and health education. All of these fall under the rubric "health promotion.''1·P·55 -00 Research can also elucidate the impact of lifestyle, not to mention psychological and sociological variables and their interaction with health behavior. Overall, the examination of health-behavior promotion is presently in the forefront in healthbehavior research. 
Gochman defines health behavior as "those personal attributes such as beliefs, expectations, motives, values, perceptions, and other cognitive elements; personality characteristics, including affective and emotional states and traits; and overt behavior patterns, actions, and habits that relate to health maintenance, to health restoration and to health improvement."2 ·P·3 Ten years ago, Gochman did not consider the human noetic nature but his definition did touch upon a basic tendency of today: that of the individual in his or her situation. 
Health as a Value 
23 24
Health is, according to Downie et al., 1• P-· a relative concept in that "health promotion must help people to better health rather than seeking a specified level of health" and, "In general [health promotion] is concerned with facilitating true well-being in adverse physical and social circumstances." The authors go on to point out four personal values: self-determination, selfgovernment, responsibility, and self-development--not as static entities but as "components of a flourishing human life." They contrast the personal values to four social values: "don't harm," "help if you can," "act justly," and "maximize 
132 140
utility."1·P· · Only out of this interplay, they argue, can the moral duty to pursue health, and not merely the avoidance of harm to others, be actualized 
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as a value. 1·P· · And "if health is among a person's values, he or she will sacrifice other things in order to achieve health, unless another value is at stake [value priority] or the person is weak-willed [noetically blocked]"1·P· 130 (brackets are mine, using logotherapeutic terms). The value of health, they conclude, is not merely a "liking value" (subjective, contingent upon the individual), but a moral value. 1•P· 131 This is due to its transsubjective quality. 
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Hyperintention and Health 
If one's intention is "I must have good health," then one hyperintends, and is destined to constantly miss the mark. The "must" leads to neurotic health behavior. Simultaneously, the "good" expresses an attitude of stagnation in instances where health can be improved. Inherent in this hyperintention is the option for no growth. "Better'' health (both physical and mental) is in fact possible in almost all situations in the rich Western world and even in the struggling third world. When better physical health is not possible, there always remains the opportunity for a change in attitude, taking a stand. 
If one's intention is, on the other hand, upon the value of health, then one takes measures that affirm the value of health and usually gains the desired somatic and ego-oriented side-effects of pleasure, happiness, wellbeing, and satisfaction with one's health condition. In this instance one can even accept and live with a situation of sickness or terminal illness with dignity. The focus becomes how one maintains, restores, improves health and even how one lives--for example, "well-adjusted to (a terminally ill] fate.''1•P·21 The logotherapeutic parallels are obvious: it is not that a person bears an illness, but how the person bears the fate. 
Personal Health and Responsibility 
Downie et al. argue that the social equality ideals of the modern welfare state must break down in favor of "a new sense of community responsibility [that is] not entirely reducible to the individual goods of the 
169 171
persons who make [the community] up.''1•P• -Thus, the oft-invoked idea of "I can do whatever I want as long as no one else is harmed" is detrimental to one's own health, and, more importantly, sends a negative, non-life-affirming attitude to the world. Health, they continue, must be achieved first at the base (at the level of the individuals) and not, as is commonly and erroneously believed, through governmental legislation. 
Individual autonomy, a chief value in life, is something that must be achieved--it cannot be given or possessed. The same is true for responsibility-it, too, is an active choice, a decision made on the level of the individual. A simple analogy: if all smokers passively wait to receive good health through anti-smoking legislation, the majority would, more than likely, never achieve any better state of health. If, on the other hand, each individual smoker were to choose not to smoke, then the majority of ex-smokers would, most likely, not fall into a state of poorer health, but rather achieve even better health. 
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An Illustration from "Health Behavior Among the Elderly" 
Dissatisfaction with exercise is one variable that has gone hand in hand with poorer perceived health status in all statistical procedures carried out in a study we conducted in Stockholm County in 1991, sponsored by the Stockholm Gerontology Research Center. While the benefits of exercise have been heralded widely, the value of exercise, much like the value of health earlier discussed, cannot be achieved via shortcuts. Here, the values of health and exercise can be seen as meanings in themselves that very likely would provide somatic and ego-oriented desirable side-effects. However, performed merely in the name of somatic or ego-centered results, exercise and health as short-term goals could be problematic. Running a marathon may sound like an activity oriented toward better health in the name of exercise. Running the same marathon untrained would be foolhardy if not directly life-threatening. 
The Role of Health Promoters 
Just as the attitude of the therapist toward the patient must show belief in the latter's ability to overcome difficulties, it is likewise true that health promoters in general must believe that there are right attitudes toward health; arbitrariness is not the path to healing. Every set of values is not as good as every other; 1·P·144 there are objective rights and wrongs. The individual with a physical or psychological ailment seeks help in order to achieve better health. True, he or she cannot be forced into following the therapist's advice, but let us remind ourselves that the patient has come seeking help. The duty of the therapist is to help the patient clarify personal values through flexible and imaginative methods, 1 to help the patient realize that the value of health is the value currently at stake, and finally to help the patient see that he or she has a role in a greater whole. Behavior followed by insight and identity is a useful order in therapy.3'4 
Conclusion 
The utilitarian view that health is only good for what it brings the individual is implausible in our world. This view inevitably leads to egocentered aims, denying the human being's self-transcendent quality. Scheler,5 on whose teachings Frankl based much of his logotherapy, spoke of eudaemonism--the belief that pleasure is the highest value or that all good and evil can be reduced to pleasure and displeasure. Setting up health as the experience of pleasure or the avoidance of displeasure is an act of eudaemonism wherein only the direct results of good health are valued. More plausible is that health is good because its side-effects grant us additional power to 
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strive for meaningful aims. The focus on autonomy as an end in itself is doomed to failure because it neglects a principal aspect of humanity--humans are social beings in community with others. 
JOHN E. STANICH is director of The Swedish Institute of Logotherapy, Box 13086, S-402 52 Goteborg, Sweden. 
References 
1. 
Downie, R. S., Fyfe, C., & Tannahill, A. (1990). Health promotion: Models and values. NY: Oxford University Press. 

2. 
Gochman, D. S. (Ed.). (1988). Health behavior: Emerging research perspectives. NY: Plenum Press. 

3. 
Haley, J. (1986). Towards a rationalization for directive therapy. In The power tactics of Jesus Christ and other essays. (2nd ed.). Rockville, MD: Triangle Press. 

4. 
Lukas, E. (1992). Work, unemployment and creativity. Seminar given in Goteborg, Sweden, 7-10 May. 

5. 
Scheler, M. (1973). Formalism in ethics and non-formal ethics of values. Evanston, IL: Northwestern University Press. (Translation by Manfred S. Frings and Roger L. Funk. Originally published as Der Formalismus in der Ethik und die materia/e Wertethik, fifth edition, 1966). 


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The International Forum For Logotherapy, 1992, 15, 104-107. 
GRATEFULNESS: A HIGHWAY TO MEANING? 
Patti Havenga Coetzer 
Patti Havenga Coetzer has been promoting logotherapy in the Republic of South Africa for many years and sponsored several speaking tours by Dr. Frankl to that country. When she recently lost her husband she wrote the following reflections which Forum readers will find relevant. 
How does one find meaning in life again when one suddenly loses the person whose very existence gave meaning? How does one find meaning when it feels like life has come to a standstill? To excel, to create, to confront life's problems may not be possible at this time of quietude when just going into the garden becomes the great event of the day. 
Outside in the garden, however, vivid colors, birds' songs, earthly scents all make an onslaught on your senses. You may not notice the movement of the trees, yet the falling leaf can be heard. So many activities occur in and around you. Here is a whole bustling world you have hardly been aware of before that morning. Somehow you are part of the scene, and the soft rays of the spring sun start stirring at the coldness inside you. You are so small. There is so little that is dependent on you, that you can control. So much has happened without your even being asked, consulted if it was the right time. 
Being aware, just being conscious, of the small happenings around you fills you first with amazement, then with appreciation. Next comes a feeling of gratefulness. For me, being aware uncovers the meaning of the moment. Recognizing the "outside" of me, the consciously opening up to it, becomes a way to a meaningful moment. 
Viktor Frankl speaks of finding meaning through creative values. And experiential values--by realizing the good, the true, and the beautiful, or by knowing one single human being in all his or her uniqueness, thus experienc
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ing love. And through attitudinal values by facing unchangeable suffering--the highest achievement we have been granted. 
A Fourth Way to Meaning? 
Driving the Frankls to the University of Pretoria where he was to give a two-hour lecture, I had planned to let them rest. But an invigorating talk ensued which ended too soon when we arrived at the University. But, yes, he agreed, gratefulness was a way of realizing meaning. The unanswered question was: is it a fourth way to meaning, or part of his famous three? 
Gratefulness could be part of experiential values. Or one could argue that it is part of attitudinal values. But I do not want to be led astray in a purely academic discussion. Gratefulness is simply a way that can be followed even when one is weak and vulnerable. Consciously using it, making a point of taking stock of all the graces you have really changes you, your view of others, of the world. 
By concentrating on those things happening to you for which you have no claim, you start distancing yourself from yourself. You start reaching out to something or someone other than yourself. To the degree that you recognize the things "spilled over you," to be able to see even the opening of a blossom, you experience humility in realizing that all these things have been "wasted" on you--at that moment you may be the only person to see that bud opening. 
By writing this, I am not subscribing to George Berkeley's perception theory: "All the choir of heaven and furniture of earth, in a word all those bodies which compose the mighty frame of the world, have not any substance without the mind ... so long as they are not actually perceived by me, or do not exist in my mind, or that of any other created spirit, they must either have no existence at all, or else subsist in the mind of some Eternal Spirit." 
Practicing gratefulness as point of departure in your journey through life is well expressed by Henry Ward Beecher: 
"If one should give me a dish of sand, and tell me there were particles 
of iron in it, I might look for them with my eyes, and search for them 
with my clumsy fingers, and be unable to detect them; but let me take 
a magnet and sweep through [the sand], and how would [the 
magnet] draw to itself the almost invisible particles by the mere power 
of attraction. The unthankful heart, like my fingers in the sand, 
discovers no mercies, but let the thankful heart sweep through the 
day, and as the magnet finds the iron, so will it find, in every hour, 
some heavenly blessings." 
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And how comforting it is to ponder Seneca's ''There is as much greatness of mind in acknowledging a good turn, as in doing it." Often it is not the wonderful young athlete, for instance, that is the most popular in school, but those who sit on the pavillon cheering their mate on. Appreciation and gratefulness go hand in hand. The attitude of being grateful can be useful in guiding children. The greatness of King David to a large extent lies in his readiness to be thankful for everything. Most of his Psalms are full of appreciation, gratefulness. 
A by-product of leading a life of appreciation and gratefulness may also be happiness. As Frankl points out, happiness cannot be pursued as an end in itself but must ensue. 
Those who suffer from existential vacuum may overcome their feeling of inner emptiness by searching for and being grateful for the seemingly small blessings. Those who go through severe anxiety should perhaps stop for a second and ponder the things they feared in the past but that have never 'caught up' with them, allowing themselves to be grateful for that. Those who say they cannot even pray, just let them spare a grateful thought toward heaven. It was Plutarch who wrote that the worship most acceptable to God comes from a thankful and cheerful heart. 
Help in Mourning 
In mourning, it helps immensely to spend a few minutes daily not just remembering but remembering gratefully. Wounds may not be healed thus, but certainly it can comfort. 
We cannot go through intense self-pity when we focus broadly and with an open mind on others around us. In the Desiderata the unknown writer advises: "If you compare yourself with others you may become vain or bitter, for always there will be greater and lesser persons than yourself." This is good counsel, yet should one look around with a deeper insight and refrain from making superficial judgments, it will be impossible to nurture self-pity. 
Gratefulness, although seldom mentioned in the indexes of Frankl's books, is definitely there. Although not perhaps called by name, it is the underlying philosophy by which Frankl lives. 
On his way to South Africa, he and Eleanor were delayed in Frankfurt, following an exhausting trip from Vienna. He described to me how the waiting lounge was overfilled. The noise level was exceedingly high as many flights were delayed. "It must have been terrible," I said, visualizing myself in that situation. 
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"Just for a minute--no, half a minute," he replied. "I asked myself if I had been in Auschwitz now, knowing that I would one day sit at the Frankfurt airport waiting for a flight to South Africa, it would have comforted my greatly." 
Gratefulness may not be the highway to meaning, but it can certainly lead to it. It exudes from Viktor Frankl's philosophy and his life! 
PATTI HAVENGA COETZER, D. Phil. [P.O.B. 65577, Benmore 2010, Republic of South Africa) studied with Frankl in Vienna and formed the Viktor Frankl Foundation of South Africa. 
News from Dr. Frankl in 1992: 
• 
On March 26, Dr. Frankl celebrated his 87th birthday. Two days later, March 28, he gave a public address at the Salesian University in Rome, Italy. 

• 
May 6, he spoke before an audience of psychiatrists and psychologists in Bratislava, capital of Slovakia. 

• 
June 10, he gave the festival address at the Medical Congress in Salzburg, Austria. 

• 
June 22, he was invited by the governor of the second district of Vienna (where he lived before his transportation to the concentration camps) to speak as part of the "Oral History Project" about his recollections as a youth. 

• 
In September he spoke at the Lomossow University in Moscow and also at the conference of Swiss, Austrian, and German societies of psychiatry. 

• 
In October he spoke in Ljubliana, capital of Slovenia. 

• 
For December, the mayor of Vienna plans the Second Viktor Frankl Symposium, to be held in the festival room of the Vienna city hall. 

• 
Also this year, Dr. Frankl's thirtieth German book was published in Vienna, richly illustrated with color photos, under the title, Experiences in the Mountains and the Pathology of Our Times. 


To conclude, an anecdote as frequently occurs in Dr. Frankl's life: His telephone rings and a voice says, "Here speaks Helmut Kohl." The German chancellor had heard last night an hour-long Frankl interview on television and wanted to tell him how deeply impressed he had been and that he had discussed it with his friends until after midnight. When Frankl asked the chancellor where he took the time, Kohl simply replied: "I'm just taking it." 
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The International Forum For Logotherapy, 1992, 15, 108-110. 
BRIEF THERAPY FOR SEXUAL DYSFUNCTION 
Uwe Eglau 
Patients in my logotherapeutic practice frequently talk about their attitudes toward love and sex. Often these are based on the common thinking of the 1980's: strongly egocentric, proclaiming their freedom without responsibility. Their line of thought is: "First think of your own pleasure. Everybody has a right to orgasm." This attitude has not led to the hoped for liberation but rather to a one-way street of loneliness. The love relationship with the partner has become increasingly unimportant. When the partner is changed frequently, people are less and less inclined to assume responsibilities. 
Two phenomena observable in sexual dysfunctions are egocentricity and hyperreflection. Clients are caught in them like a web. The more they try to escape, the more they become entangled. 
The damage done by egocentricity is less from egoistic thinking per se, and more from "navel gazing" (i.e., overanalyzing their problems to the extent that the rest of the world is crowded out). Only the I is observed, the Thou becomes increasingly insignificant. 
Hyperreflection, a well-known logotherapeutic term, means a constant, almost compulsive, concentration on one problem--in the present case, sexual dysfunction. Clients think only of their own pleasure and chase after their potency; which usually is fast escaping. 
According to Frankl, pleasure is not accessible by directly chasing after it, but is a by-product of a meaningful deed or experience. When patients pay less attention to their partners, and keep chasing after their own pleasure, their "will to pleasure" blocks the way. The way to sexual pleasure is through self-surrender and selflessness. It is necessary to convince patients that sexual pleasure and potency, in the last analysis, is the result of a deep, spiritual capacity to love. Their attention must not be focused on a physical or psychological goal toward which they are driven, but must be focused on a Thou whom they have chosen. 
The methods Viktor Frankl developed for sexual disturbances are excellent for impotency cases. I work together with my wife, who takes care of the medical aspects when needed. I contribute the logotherapeutic part, which in many cases is sufficient. 
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Three Case Histories 
Mr. M, manager in an industrial enterprise, appeared a stressed man. Recently he suffered from problems with his potency. He had erections in the morning and at night, also when masturbating, but not with his wife to whom he had been happily married for 20 years. 
At the first consultation he reported to be under time stress. His working day began at 5:30 a.m. and usually ended after 10 p.m. Arriving home late at night, his wife sometimes indicated sexual desire. In such moments he felt cornered, his wife's demands appeared to suffocate him. For three months he had been unable to have sexual intercourse with her. He still had erections but not with his wife. Mr. M, without being asked, volunteered that he tended to observe himself, even during foreplay. 
In Socratic Dialogue the hierarchy of his values was clarified. Work and profession had become, unnoticed and unintended, his top values. Because of his extreme overwork, all moments of self-transcendence disappeared in the evening when he came home to his wife. Intercourse with her was only a duty. He was torn between his profession and his wife, both of which he loved but were no longer compatible. After a few treatment sessions Mr. M reported that he rearranged his working hours so he had more time for his family. After an extensive talk with his wife about the home situation and possible solutions, they resumed intercourse, satisfying to both. 
Mr. B, 40 years old, also suffered from impotency. For years he had been a patient in our ambulatory clinic because of his inability to have children. The quality of his semen, which contained 80 percent immovable sperms, could be improved only insignificantly through medication. His wife was treated medically because of impenetrable tubes, also without success. Nevertheless, the couple was given a plan for sexual intercourse: they were advised to have sex, after five days of abstinence, on the fourteenth day of the female cycle. This programmatic procedure and their concentration on procreation led to a weakening and eventual loss of Mr. B's potency. The sexual act lacked any element of self-transcendence, and all spontaneity had been lost through the "medical prescription" of the intercourse. Mr. B's failure was his unconscious refusal to be used as a mere means to an end. 
After our first treatment session with Mr. B, Mrs. B was invited to a logotherapeutic consultation. Her feelings were similar to those of her husband. In this session I explained to the couple that it seemed unlikely that they could have children, and that they would do better to accept this fact as unavoidable. A modification of attitudes was indicated. I forbade intercourse for two weeks--in this kind of therapy it is important to relieve their hyperreflec
109 
tion on procreation, and the two-week prohibition of sex was to serve that purpose. After two weeks the couple reported that they couldn't keep their abstinence and had succeeded in a pleasurable encounter. 
Mr. P, 40 years old, came for help because of premature ejaculation. He reported that, after three years of abstinence, he had found a sexual partner again. During the three years, he masturbated regularly and noticed no change in his sexual capabilities. Upon entering our therapy, he reported no problem with erection but experienced ejaculation before or immediately after penetration. 
At first, I told Mr. P that premature ejaculation often follows a long abstinence. I recommended a second coitus, one hour after the first, and treatment with xylocain-gel. This did not help. We then started a Socratic Dialogue. It turned out that Mr. P in the past few years had developed a fear of committing himself to a relationship. When his present partner became interested in him, he was flattered. He overcame his fear quickly because his relationship with the woman developed well in spite of his sexual trouble. But Mr. P admitted that he was not much interested in his partner as a person. I pointed out to him that he saw his partner mainly as a sexual object. As long as he directed his sex drive at her only as an object, the premature ejaculation could continue. Only when he would see her as a person, in her uniqueness, with all her strengths and weaknesses, would he be able to counter his hyperreflection which ultimately was responsible for his ejaculation problem. 
These are just three examples that demonstrate, once more, that the methods Frankl has developed since 1947,1 effectively help in cases of sexual dysfunction. More essential, however, than all the logotherapeutic techniques is the change in attitudes that takes place in the dimension of the spirit.2 
UWE EGLAU [Urologische Universitatsklinik, AKH-Wien, Alserstrasse 2, A-1090 Vienna, Austria] is a logotherapeutic counselor at the Department of Urology, University Clinic, Vienna, Austria. 
References 
1. Frankl, V. (1947). Die Psychotherapie in der Praxis. Munich: Piper. 
2. Frankl, V. (1983). Arzliche See/sarge. Frankfurt/Main: Fischer. 
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The International Forum for Logotherapy, 1992, 15, 111-115. 
LOGOTHERAPY IN CHILD GUIDANCE 
Jim Lantz and Karen Harper 
The function of the logotherapist in Franklian child guidance is to help parents and children uncover, discover and make use of the meaning opportunities that exist in family life.4 In a Franklian approach, paucity of awareness of meaning produces a family meaning vacuum that can be filled by the develop
134
ment of family symptoms. • • A family meaning vacuum can be operationally defined as a mean family score of less than 93 on the Purpose in Life Test.4 The therapist helps the members shrink this meaning vacuum through the development of family meaning awareness, thus decreasing the frequency of symptoms that grow in the family meaning vacu
um_ 1,2,a,4 
The Family and the Child 
A basic assumption in Franklian child guidance is that parenting and raising a child are among the most difficult yet meaningful activities in human living. When a child is having emotional, behavioral, and/or developmental problems, these problems are often either creating or signaling the presence of a meaning disruption in the 
136
lives of the parents. ' ' In this view, parents who are having problems raising 
12 3 45 
a child are often experiencing an existential meaning vacuum. •••• 
In Franklian child guidance it is believed that at times children develop problems in reaction to a r:T1eaning vacuum in the parental relationship and that at times the parents develop a meaning vacuum reactive to the stress of raising a difficult and/or problem child. 1'3 In both situations, Franklian child guidance could be considered the treatment of choice. 


111 
A common observation reported by many family therapists and childguidance specialists is that at times the development of problems in a child is a logical reaction to existential problems in the parents' marital relationship.1'3'4 The following family dynamic (called the "minor as marital therapist syndrome"3) is just one example of the many ways that problems in a child can be a reaction to a meaning vacuum in the parents' marital relationship. 
In the minor as marital therapist syndrome the child becomes frightened and anxious when the parents start to manifest marital conflict in 
3 
an open way. The child becomes anxious as a result of having learned from the parents that anger /conflict is a terrible thing, to be avoided at all cost. As a result, whenever the parents begin to manifest conflict openly, the child begins to act out. Such acting out may include temper tantrums, psychosomatic illness, or running away. As soon as the child displays the symptoms, the parents drop the conflict and run to the child with sympathy and concern, thus rewarding the child for displaying the problem behavior. This process is reciprocal. The parents reward the child by giving sympathy for symptom development, and the parents in turn are rewarded by no longer needing to concentrate on (or resolve) their own conflict. This in turn disrupts parental meaning awareness. Both parents and child agree that conflict is a "terrible thing," and each family member does his or her part to ensure that "things don't get out of hand." This process can be interrupted, challenged, and changed with the help of a logotherapist who refuses to let the married couple avoid intimacy and meaning because of their fear of conflict. Intervention is centered upon helping the parents learn to resolve conflict rather than avoid it, helping the parents find meaning through and/or in spite of conflict, and helping the child give up problem behavior that serves the "marital-therapist"
3
function for the family. In other cases the development of emotional, behavioral, or devel
135
opmental problems in the child is not a reaction to parental pathology. · • Many problems developed by children are reactions to physical problems, learning disabilities, neurological impairments, attention deficit disorders,
135
hyperactivity, and other handicapping conditions. · • In such cases, parents often develop an existential meaning vacuum in reaction to the stress of raising a difficult child.3 Here, the parents need to learn specific child management skills that will help this unique child grow and develop so the parents can more effectively actualize the meaning potentials that are part of 
1 6
raising and loving a special child. '3' 
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Stages in Franklian Child Guidance 
In our view, there are three stages of treatment in Franklian child guidance: a) the child-centered stage, b) the parent-centered stage, and c) the community-centered stage. These three stages should be followed both when problems in a child are a reaction to a parental meaning vacuum and when the parental meaning vacuum is a reaction to the problem child. 
In the child-centered stage the logotherapist arranges a complete biopsychosocial assessment of the child. At our Center we use the services of a pediatrician, a psychologist, a learning specialist, a speech therapist, a psychiatrist, and a social worker to perform a complete assessment (including psychological testing) of the needs of the child and to decide what treatment to recommend to the school and the parents. During the child-centered stage we determine both the strengths and problems of the child as well as interventions that should be helpful. Recommendations may include medication, concrete learning activities for school or preschool, speech therapy, individual psychotherapy or play therapy, and at times occupational therapy. In almost every instance, we outline special and specific parenting strategies for the parents to use at home in encouraging and directing the child. These parental recommendations are given not only because of the needs of the child but also as a joint task for the parents to work on together.3 The recommendations to the parents signal the start of the parent-centered stage of Franklian child guidance. 
In the parent-centered stage, the parents are given specific child management assignments to use at home to help the child's growth and development.3'6 For example, we might teach parents methods of holding a child's attention, how to use "time out", and how to use a behavioral reinforcement technique. The parents are asked to change existing child management methods in view of their child's special needs. They are told that we do not believe they are bad parents, but that their "normal" child management methods need to be adapted to their child's "unique needs" discovered in the child-centered stage.3 This usually decreases parental feeling of guilt and helps avoid parental resistance to new child management methods. 
We have found that parents who are experiencing a meaning vacuum reactive to the stress of raising a special or handicapped child will generally implement the suggested changes without a great deal of resistance. Often they express considerable appreciation for the new ideas and child management methods that trigger dramatic improvements. The parents also begin to experience an increase in their sense of the meaning and purpose in life 
113 
because they view themselves as more effective parents. In logotherapy terms, they begin to fill the parental meaning vacuum with creative and experiential meanings that are a part of doing a good job raising a difficult child. 1'3'5 
Sometimes parents resist implementing the new child-management tasks which the treatment team prescribes because the parents are unable to work with each other on a joint relationship task. 1'3 .4 In this situation, marital pathology disrupts the parents' ability to implement the recommendations. The parents' difficulty in working together for the child provides an excellent opportunity for the parents to become aware of their marital problems, to see how their problems create difficulties for their child, and to understand the importance of marital therapy for both themselves and for the sake of their child. 1'3 In this situation, both marital therapy and child guidance activities are recommended additional to psychotherapy for the child. This gives the parents an opportunity to improve both their child management skills and their marriage.1'3 We often use conjoint family interviews to help in both childguidance and marital-therapy activities toward the end of the parent-centered stage of treatment.3'4 A dramatic increase in the parents' sense of meaning and purpose in life often occurs toward the end of the parent-centered stage of treatment.3 
Most approaches to child guidance and/or family treatment stop at the end of the parent-centered stage. This is not true in Franklian child guidance. Here the logotherapist believes that self-transcendence is a major healing factor, so the community-centered stage is facilitated before therapy is considered finished. It is powerful medicine when parents who are receiving help look beyond their own family and start to consider what they can do to help others who have experienced similar problems.3'6 For many parents, this self-transcendent concern for other children and other families is a natural and healthy realization that their own resolution of marital problems and/or parenting difficulties can be utilized to benefit the work of others. In this view, an important task of the logotherapist is to connect the child-guidance client to other parents who are also interested in giving to the world in honor of their personal triumphs and previous pain.3'6 
JIM LANTZ, PH.D. and KAREN HARPER, PH.D. are staff members at the Worthington Logotherapy Center {6641 High St., Suite L, Worthington, Ohio 43085, U.S.A.] and faculty members at The Ohio State University College of Social Work. 
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References 
1. 2. 3. 4. 5. 
6. 
Andrews, E. (1974). The emotionally disturbed family. NY: Jason Aronson. Frankl, V. (1967). Psychotherapy and existentialism. NY: Simon & Schuster. Lantz, J. (1978). Family and marital therapy. NY: Appelton Century Crofts. Lantz, J. (in press). Family therapy and Viktor Frank/'s existential analysis. NY: Jason Aronson. Riemenschneider, A. (1986). Understanding the parent whose child is mentally retarded/developmentally disabled. In A. Riemenschneider (Ed.) Parent-professional interaction: A key to parental involvement. Columbus: The Ohio State University College of Social Work. Weisberg, L., & Greenburg, L. (1988). When acting out isn't acting. NY: Bantam Books. 

UWE EGLAU logotherapeutic counselor at the Department of Urology, University Clinic, Vienna, Austria. 
115 

The International Forum For Logotherapy, 1992, 15, 116-119. 
UNCONSCIOUS RELIGIOUSNESS AND THE UNCONSCIOUS GOD 
Christoph Kreitmeir 
Viktor Frankl adds the spiritually unconscious / to Freud's instinctively unconscious It. Thus he finds an unconscious religiosity or relatedness to God within human spirituality. "This unconscious religiousness," he writes, "revealed by our phenomenological analysis, is to be understood as a latent relation to transcendence inherent in man.''6' P·51 
Frankl incorporates God's existence in his terms "ultimate meaning" and "supra-meaning." These meanings transcend the human being and cannot be apprehended by rational processes. This must be done by an existential act that Frankl calls "basic trust in Being."4' P·27 And he goes on: "It is my contention that man really could not move a limb unless deep down to the foundations of existence, and out of the depth of being, he is imbued by a basic trust in the ultimate meaning."8' P-150 
For Frankl, "basic trust in Being" and "basic trust in ultimate meaning," however dormant they may be, are transcendental. Hence they are indispensable for human existence.8' P-151 
Scientific Psychotherapy or Secular Religion? 
"Unlike many European existentialists, Frankl is neither pessimistic nor antireligious," writes Gordon Allport. "On the contrary, for a writer who faces fully the ubiquity of suffering...he takes a surprisingly hopeful view of man's capacity to transcend his predicament and discover an adequate guiding 
12 13
truth."7' P· • 
The uniqueness of Frankl is that he developed not only helping techniques, but also a philosophy of life. Logotherapy is a system of values and something like a "secular religion." 
Even though Frankl deals with subjects like conscience, values, meaning, unconscious religiousness, and supra-meaning, logotherapy as a 
116 
secular theory and medical practice must restrict itself to factual statements. Logotherapy must leave to the patients the decision as to how to understand their own responsibleness: whether along the lines of religious beliefs or 
5 54
agnostic convictions. "Logotherapy must remain available to everyone" ' P--patient or doctor, believer or nonbeliever. Again and again Frankl insists on neutrality because fusion "of psychotherapy and religion necessarily results in confusion, for such fusion 
144
confounds two different dimensions, ...anthropology and theology.''a. P· There is a dimensional difference between the divine and the human world just as 
144 45
there is between the human world and the world of animals.8' P· · 
There is also a dimensional difference between psychotherapy, including logotherapy, and religion. When dealing with God we must be aware of the danger of making Being into a thing and remember Ludwig Wittgenstein's words, "whereof one cannot speak, thereof one must be silent." "In other words, man cannot speak of God but he may speak to God. He may
146 
pray_ ..a, P-We must be aware of authoritarianism, rationalism, and anthro
149
pomorphism as stumbling blocks which try to conceptualize God.a, P• 
Frankl clearly sees the function of logotherapy, saying that it "does not cross the boundary between psychotherapy and religion. But it leaves the door to religion open and leaves it to the patient whether or not to pass the 
door_.,a. p.143 
Any helper working with logotherapy should not try to outdo the priest.6' P•73 But even Frankl acknowledges "that his system ultimately leads to faith."1•P• 17 
A Bridge between Religion and Psychotherapy 
We need to follow Frankl's advice to be careful and not mix different dimensions when we look at religion, psychotherapy, and logotherapy. Religion is our "awareness of the suprahuman dimension and the basic trust 
2
in ultimate meaning residing in that dimension.''3' p.,a The goal of religion is salvation.8' P-143 True religion "is so forceful because it satisfies the oldest,
11 46
strongest, and most urgent of all human longings" · P---the search for meaning in each situation. Psychotherapy, on the other hand, is "a technique
190 91
of stimulating and educating one to deal with problems"2• P· · with the goal
143
of healing and mental health_a. P-
Logotherapy, in going beyond the psychotherapies of Freud and Adler, incorporates the spiritual human dimension and works with terms like "meaning," "values," and "unconscious religiousness." It focuses on searching for meaning and purpose in life, and is regarded as "the most systematic of 
117 
all the existential approaches to counseling and psychotherapy."12• P-195 It is "implicitly religious in the sense that it assists in the aspiration for the supreme good of human development, but is not explicitly religious as a presentation of sectarian religious dogma."9' P· 23 It is not a special Protestant, Catholic, or Jewish psychotherapy8' P·143 even if many scholars such as Ungersma, Tweedie, Leslie, Bulka, and Boschemeyer connect it with these and other beliefs. 
Frankl opens the psychiatrists' and psychotherapists' doors not to any particular religion, but to religion itself. Frankl is helping to overcome the spiritual crisis of our time with ways of thinking and the language of our time. "Thus logotherapy can be a true bridge between religion and psychotherapy for life-meaning that exists in one's situation and can help one to find therein a religious component, and in turn accept psychotherapy as a step in fulfillment of that meaning."2• P· 191 But logotherapy must stay apart from religion for the sake of its independence and scholastic future. 10• P-2425 
CHRISTOPH KREITMEIR [St. Anna St. 19, 8000 Munich 22 Germany] is a Franciscan friar in Bavaria, Germany, and has worked as a social worker with the homeless and as a logotherapeutic counselor. 
References 
1. 
Bulka, R. (1974). The ecumenical ingredient in logotherapy. Journal of Ecumenical Studies, Winter, 12-13. 

2. 
Crumbaugh, J. (1979). Logotherapy as a bridge between religion and psychotherapy. Journal of Religion and Health, 18, 188-191. 

3. 
Fabry, J. (1968). The pursuit of meaning. Boston: Beacon Press. 

4. 
Frankl, V. (1962). Logotherapy and the challenge of suffering. Pastoral Psychology, 13, 25-28. 

5. 
Frankl, V. (1964). The philosophical foundations of logotherapy. In E. Strauss (Ed.), Phenomenology--pure and applied. Pittsburgh: Duquesne University Press. 

6. 
Frankl, V. (1975). The unconscious God. NY: Simon & Schuster. 

7. 
Frankl, V. (1987). Man's search for meaning. NY: Pocket Books. 

8. 
Frankl, V. (1988). The will to meaning. NY: New American Library. 

9. 
Grollmann, E. (1964). Viktor E. Frankl: A bridge between psychiatry and religion. Conservative Judaism, 19, 22-38. 

10. 
Kalmar, S. (1988). The secular character of logotherapy. The International Forum for Logotherapy, 11, 23-26. 


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11. 
Kung, H. (1990). Freud and the problem of God. NY: VailBallou Press. (Originally published under: Freud und die Zukunft der Religion, in Kung, H., 1978, Existiert Gott? Munchen: Piper.) 

12. 
Smith, D. (1987). Logotherapy. In D. Benner (Ed.), Psychotherapy in Christian perspective. Grand Rapids. 


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ISSN 0190-3379 IFODL 15(2)65-128(1992) 
The International Forum  
for  
LOGO THERAPY  
Journal of search for Meaning  
Welcome to the New Viktor Frankl Institute in Vienna  65  
Meaning in Industrial Society  66  
Viktor E. Frankl  
Meaning, Purpose, and Leadership  71  
Robert A. Levit  
Suffering in a Nursing Home: Losses of the Human Spirit  76 L--·  
Patricia L. Starck  
The Meaning Walk: A Logotherapy Retreat Experience  80  
Florence I. Ernzen  
Lucy's Story: A Logotherapy Encounter  83  
Ann G. Westermann  
Assessing the Logotherapeutic Value of 12-Step Therapy  86  
John M. Majer  
Meaning and Goals in the Chronically Ill  90  
Elisabeth Lukas  
The Value of Health: Current" Direction of Health-Behavior Research  99  
John E. Stanich  
Gratefulness: A Highway to Meaning?  104  
Patti Havenga Coetzer  
News from Dr. Frankl in 1992  107  
Brief Therapy for Sexual Dysfunction  108  
Uwe Eglau  
Logotherapy in Child Guidance  111  
Jim Lantz and Karen Harper  
Unconscious Religiousness and the Unconscious God  116  
Christoph Kreitmeir  
New Book on Frankl  120  
Abstracts of Recent Publications of Interest to Logotherapists  122