Volume 17, Number 1 Sprtng 1994 
• 

The International Forum for Logotherapy, 1994, 17, 65-69. 
WHEN AN OFFSPRING DIES: LOGOTHERAPY IN BEREAVEMENT GROUPS 
Gustavo Berti and Alicia Schneider Berti 
The loss of a child Is a severe existential challenge for which no previous experience has prepared us. In most cases, no appropriate help is available from agencies or professionals. 
Four years ago we established the first group in Rio Cuarto, Argentina, for bereaved parents with whom we have shared painful life experiences, sorrow, compassion, and finally, love. The first group was initiated on December 5, 1988, six months after our 18-year-oid son Nicolas died in a motorcycle accident. 
During the first year of the group we gained much experience in selfmade fashion. We also learned from Elizabeth Kubler-Ross that the grief process in bereaved parents closely matched the stages a dying patient goes through: a) shock, denial ("not my child," ''why me," "why my child"); b) anger, rebellion (''there is no God," "life is worthless"); c) bargaining, usually with God ("if you let me see my child once more, I promise you..."); d) depression; e) acceptance.1 Without social support, we have seen parents stagnate in any of the first four stages. 
Initially we worked intuitively with the concept that, amidst so much adversity, we should not just survive, but somehow we should survive with dignity. At that time, we were not aware that we were witnessing the "defiant power of the human spirit" reaching deep into the dimensions of human freedom and not subjected to deterministic laws. 
A year later we came across Frankl's Man's Search for Meaning. As we read it, we experienced the aha! phenomenon. It was exactly what we were doing in the group, proving thus that Dr. Franki's logotherapy can be applied by the common human being with no previous knowledge on the subject, when confronted with inevitable suffering. 

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We found a parallel between our feelings and those of the prisoners in concentration camps. Confronted with our dead child, we felt as Frankl did, "all we possess Is our naked existence.''2' p.33-34 It showed us, in all its rawness and for the first time, the transitoriness of life. We, like the prisoners, ceased to live for the future. The whole structure of our life changed. The mere thought of a future without our child became unbearable. Other points in common with logotherapy became evident, particularly: a) dealing with life from this moment onward, b) working with the stronger aspects of ourselves. and c) making us see that we are not helpless victims of fate. We were exercising logoattltude, since In the groups we are not professionals but parents. 
The Question of Meaning After A Severe Loss 
As the work with the groups proceeded It became clear that, as Elisabeth Lukas points out, •never Is meaning so much in the minds of people as after a severe loss. •3• P-79 All bereaved parents ask what meaning is left in life. Some fear the existential vacuum that seems just ahead, while others realize for the first time that the vacuum has always been their road companion. 
Just as Frankl said to his fellow prisoners, we tell members of the group that It does not matter what we expect from life, but rather what life expects from us; we need to stop asking about the meaning of life and rather become aware that we are the ones being questioned by life.2• P-98 
How we answer those questions will make the difference between a life full of meaning or one lived In despair and sadness. It will make the difference between finding meaning behind our child's death, or crying forever about questions which have no answer, allowing our lives to be destroyed by the very person we love the most. If we choose searching for meaning by living our lives in our child's name, we make our child transcendent by the very way we live. In other words, we choose to live responsibly. 
When parents lose their only child, or all their children, they may dismiss life as •not being worth living.• Like many prisoners in the concentration camps, they feel they have nothing to live for, their life seems to be void of meaning. Here Frankl's thought •you may not expect anything from life but life still expects something from you.• proves especially pertinent. 2• P-98 
We stress that as unique beings we deserve to live a meaningful life. We challenge group members to discover what tasks life still holds for them to fulfill. Nobody can live our lives for us. The group can sustain us, support us, love us, and guide us, to find our way, but It cannot bear our individual crosses. Our unique opportunity lies in the way in which we bear our burden. 
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Knowing that our suffering may have a meaning makes us realize its hidden opportunity for achievement, making it easier to bear. 
According to Frankl, there are three main avenues to arrive at meaning in life: creative, experiential, and attitudinal values. We have seen these actualized in our group. 
Parents can realize meaning as they choose to bear their suffering with dignity, emerge wiser, and become more loving. They realize that when confronted by the Irreversible they stUI have the last of human freedoms, to choose their attitude. Are they going to be like the weak leaf. blown away by the first wlnds?--or like the tall, strong, yet flexible tree, that bends over then stands erect once the storm Is over? 
Parents In our groups are living testimony that there is a human dimension that helps us transcend ourselves toward goals beyond ourselves, toward meaning higher than personal needs. It Is this spiritual freedom that makes life meaningful and purposeful. We know that we owe this much to our children and we owe it to ourselves. 
Three Stages In Bereavement Groups 
Members in our groups go through three stages. The first stage is catharsis. Newly arrived parents are Invited to share their experiences with the group; for some it takes more than one meeting to do this. The objective is for the parents to verbalize their negative feelings--their anger and guilt. The group, at this stage, shows unconditional acceptance and support. 
The purpose of reviving, exploring, and examining their painful reality is for the parents to realize the situation in which they find themselves--"where they stand.• They see they are no longer alone; they are not the only ones suffering. Freely expressing the painful experience allows parents to put some order in the chaos of the feelings characteristic of this stage--io sort things out.• It also permits them to objectify their feelings, thus self-distancing themselves from their situation and allowing them to move on to the next stage. 
In this catharsis stage the feelings of guilt and loss of self-respect predominate; the danger of hyperreflection exists. We have found that to "work things through• is not appropriate at this time. On the contrary, it is the present that has to be considered and the future has to be planned. The group shows new members the futility of focusing into the past since it cannot be changed. At the same time, the positive potential in guilt is stressed--they can learn from their mistakes so as not to repeat the mistakes. This redeeming attitude helps them recover their lost self-respect. 
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The catharsis stage gives way to the second, the enlightenment stage, which begins with acceptance of the reality and coming to terms with the fact: "I'll never have my child back." At this point, the parents learn to "let the child go with our permission.· We have found that "to let our children go" Is a very important step in order to leave anger and rebellion behind, and concentrate on answering the question: "What do I do with my life from now on?". Up to that moment, the parents' feelings have not allowed them to see things clearly. As they accept their situation, they listen and consider the positive Ideas and perspectives expressed by the more experienced members of the group who "have already been there.· This offers the parents the opportunity to see themselves reflected In the other parents who act as mirrors and help them move forward toward understanding, acceptance, and finally transcendence of negative feelings. 
The enlightenment stage helps parents clarify concepts and Ideas that were considered until that moment from a totally negative perspective. Especially useful here are dereflection and self-transcendence. Parents learn how their situation and feelings can be seen from a different point of view that is more comforting and constructive. Emphasis is placed in the positive aspects of the survivors' lives--their strong points that will help them build on from there. 
As more positive things are discovered the parents are able to see life as feasible again, although In a different way. Until that moment, grief made them conscious of their own needs-they felt no one suffered more than them. In the enlightenment stage they Include others In their considerations. By simply reaching out to others to lend a hand, their suffering is lighter to bear. As logotherapy puts it, the defiant power of the human spirit is a liberation from egocentricity and hyperreflection. In Elisabeth Lukas' words: "It is a thrust into the human spirit_..a. P·142 The sooner the parents transcend their own grief, the sooner they take responsibility for their own lives. 
The last stage is life-planning. As the parents transcend crippling negative feelings, life once again is considered from the present onward--something they had been unable to do since the death of their child. The group continues to support, guide, and help the parents find new meanings in their lives--meanlngs that rescue from the past all that helps them face this new reality and projects hope toward the future. 
In the life-planning stage the parents see themselves in a different perspective. They actualize their social values through strength, courage, and compassion to others. Then their self-respect Is restored. They are proud they 
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have accomplished meaning in suffering. They are able to be aware that they have turned a personal tragedy into triumph. 
GUSTAVO BERTI, M.D. [San Lorenzo 1325, Rio Cuarto, Argentina] is a diplomate of the American Board of Neurological Surgery, a member of the Argentinean College of Neurological Surgeons, and head of Neurosurgery, lnstituto Medico, Rio Cuarto, Argentina. 
ALICIA SCHNEIDER BERTI is a professor of foreign language (English) at the lnstltuto lanteriano La Merced, Rio Cuarto, Argentina and a member of the Association of Professors of English In Argentina. 
References 
1. 
Kubler-Ross, E. (1985). On children and death. NY: MacMIiian. 

2. 
Frankl, V. (1985). Man's search for meaning. NY: Washington Square Press. 

3. 
Lukas, E. (1986). Comfort in crisis through logotherapy. Berkeley: Institute of Logotherapy Press. 


Aphorisms by Elisabeth Lukas 
Logotherapy opens our eyes to see that we are people who have to respond; what we see with our eyes open Is that we are responsible. Self-distancing means, among other things, to laugh about ourselves. Every crisis has Its chance and every suffering has its meaning. Our investments in "education for being human" are our premiums for the only life insurance of humanity. Self-pity Is like a whirtpool that will drag you down into hopeless depths. Material gain is dead if life is not breathed into It by meaning. To become human is not easy--not at the physical birth, nor at the spiritual. Logotherapy does not aim at uncovering, nor at covering up, but at discovering. 
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have accomplished meaning in suffering. They are able to be aware that they have turned a personal tragedy into triumph. 
GUSTAVO BERTI, M.D. [San Lorenzo 1325, Rio Cuarto, Argentina] /s a diplomate of the American Board of Neurological Surgery, a member of the Argentinean College of Neurological Surgeons, and head of Neurosurgery, Jnstituto Medico, Rio Cuarto, Argentina. 
ALICIA SCHNEIDER BERTI is a professor of foreign language (English) at the lnstltuto lanteriano La Merced, Rio Cuarto, Argentina and a member of the Association of Professors of English In Argentina. 
References 
1. 
Kubler-Ross, E. (1985). On children and death. NY: MacMillan. 

2. 
Frankl, V. (1985). Man's search for meaning. NY: Washington Square Press. 

3. 
Lukas, E. (1986). Comfort in crisis through logotherapy. Berkeley: Institute of Logotherapy Press. 


Aphorisms by Elisabeth Lukas 
Logotherapy opens our eyes to see that we are people who have to respond; what we see with our eyes open is that we are responsible. Self-distancing means, among other things, to laugh about ourselves. Every crisis has its chance and every suffering has its meaning. Our investments in "education for being human" are our premiums for the only life insurance of humanity. Self-pity is like a whirtpool that will drag you down into hopeless depths. Material gain is dead if life is not breathed into it by meaning. To become human is not easy--not at the physical birth, nor at the spiritual. Logotherapy does not aim at uncovering, nor at covering up, but at discovering. 
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The International Forum for Logotherapy, 1994, 17, 70-75. 
The Meaning of Chronic Headache-The Role of the Human Spirit in Conflict Resolution 
Ingeborg van Pelt 
Physicians frequently are faced with complex issues when serving patients suffering from chronic headache. The traditional approach based on pathophysiology and psychopathology does not appear to suffice. Therefore, the biopsychosocial model has evolved. It is used in behavioral medicine and emphasizes behavior modification as an additional way of treatment. 
Frankl's tri-dimensional model of body, psyche, and human spirit can effectively assist physicians and other clinicians in treating people afflicted with chronic recurrent headache. With its main emphasis on the healthy core, it gives therapists and patients the opportunity to shift from preoccupation with pathology to intactness and wholeness. If the reassurance of inner strength becomes the first step of the therapeutic effort, the gate is opened to active participation in conflict resolution or attitudinal change. 
Illustrative Case Histories Case 1 
A 58-year-old woman was brought to the Headache Clinic by her daughter-in-law because of chronic, daily headaches that caused many days of absence from work and heavy use of pain medication. When her daughterin-law prodded her: ''Tell the doctor what you take,· she admitted she treated herself regularly with 600 tablets of Aspirin, ordered from Greece every 2 months, in addition to about 200 tablets of American Aspirin. When she was asked about the foreign shipment, she replied that she was a native of Greece and that she obtained more pain relief from her homeland medication. These remarks opened the door to an inquiry about her family and personal life. 

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To the astonishment of her daughter-in-law she was able to share her feelings which Included homesickness and a lonely life without her husband. She broke out In tears when she talked about her ·only daughter-who had died 8 years eartler of meningitis. She had not only lost her daughter, but also had become distant to her grandchild as well because her son-In-law had remarried. In addition, she now felt deprived of the security and consolation for her old age because she had expected to live with her daughter. When asked where she was living now, she replied, -With my son and my daughterIn-law, who are very good to me, and I love my grandchildren. ¦ The visit ended with the assurance that there was hope to get rid of her pain. (This was also expressed In a letter to her employer.) The physician then explained to her that she was suffering from tension-type headache aggravated by drug overuse. She accepted this evaluation. She agreed to diminish the aspirin intake and try Instead a low dose of Amltrlptyllne at night. 
When she returned 2 months later, she entered the office alone and with a smile on her face. Her headache had drastically decreased. She had taken only about 1 O aspirin during this period of time, although she had run out of the Amitriptyline after 2 weeks. She had returned to work shortly after the first visit and stated that she felt healthier, more energetic, and more confident about the future. 
Case 2 
A 22-year-old young man visited the physician after two weeks of daily headache. His medical history and physical examination was unrevealing, and no organic cause could be identified. The physician decided to alleviate the pain with medication and observe the course of headache. Before the young man left the office, the physician voiced her concern about the recent cross burning on campus and asked for his reaction. He suddenly became rather agitated and articulated his anger and frustration about societal Injustice and racial discrimination. He then shared with the physician that he, as a white junior administrator, had joined black students in the occupation of an administrative building. During this conversation he suddenly realized that his headache had started that day, and to his amazement he felt relief from his pain after this catharsis. He became headache free during the next days without the initially suggested medication. 
Case 3 A 21-year-old student sought consultation with a physician because of daily headache. He denied any recent physical illness and was unaware of any 
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triggers. Although he was busy with school, he felt that everything was well under control and that he did not experience stress. However.the questioning did not stop here; the physician suggested possible distress.rather than work overload. She mentioned conflict, anger, fear, and anxiety as frequent causes of headache. At this point, the patient faced the physician and responded: "You are the first one I mention this to. I had a sexual relationship last summer, which I should never have engaged in." He alluded to a homosexual experience. The physician then suggested to him that he evaluate the conflict: possible bodily demands versus emotional desires; uncertainty about personal values, family values, and societal expectations. During this conversation he became aware of his distress and its possible connection with the headache. His pain lessened within a few days. During the follow-up visit, he mentioned that he was seeking pastoral counseling and that he had undergone HIV testing. He was no longer concerned about headaches. 
Case 4 
A 58-year-old woman presented to the headache clinic because of five years of daily headache. The pain would awaken her at 2:30 AM and persist until 5:00 AM. Throughout this period she would sit at the kitchen table and hold her badly hurting head. She had been unable to find relief with medication, but had endured this pain because she knew that it would not last longer than 2-3 hours. She would be headache-free for the rest of the day and night. (Medically her symptoms met the criteria for chronic cluster headache.) The interview went beyond the traditional medical history, because five years of daily pain indicated to the physician chronic suffering. Who was this woman? What gave her the strength to come now to this clinic and ask for help? The physician, therefore, decided to let her tell her story. She confided that she grew up In an alcoholic family; one son died of a drug overdose and another was imprisoned on a murder charge . The physician's response to this revelation was: "You are a remarkable woman, you have been able to carry on in spite of all your pain. Let us see how we can conquer your headache!" The woman's spirit lifted after these remarks, and she became an eager participant in her treatment plan. This consisted of a trial with medication for the cluster headache, an appointment with a psychiatric social worker in order to discuss family matters and future plans-she had indicated that she would like to go back to work and perhaps get her high school diploma once her headache had Improved. Her daily headache ceased after this first visit. She had only two pain episodes during the next two months while she struggled to make the right decision for permanent care for her ailing mother. The 
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physician reassured her that these two episodes did not mean regression; instead, it solidlfled the impression that her pain was stress Induced and that she would be able to master it. She was reminded of how she had demonstrated strength and courageous decisive action during the past months, and how, in the process, she had conquered her pain. 
The Meaning of Pain 
The phenomenon of pain can be seen as a blessing or a source of suffering and despair. It Is a blessing when it brings the person to seek evaluation and remedial treatment. It becomes a source of suffering and despair when medical treatment does not bring relief. Eric Cassel writes: "People frequently report suffering from pain when they are out of control, when the pain Is overwhelming, when the source of pain is unknown, when the meaning of pain Is dire or when the pain Is chronic."1 
The four case histories were chosen to demonstrate the complexity of the headache phenomenon. In case 1 the medical history and physical examination of the Greek woman fit the medical diagnosis of tension-type headache. This type of headache is often identified with stress, and one searches for work over1oad, physical exhaustion, and burn-out. As could be demonstrated in the case history an Inquiry of this kind would not have revealed the origin of pain. Therefore, other possibilities had to be taken into consideration. What did this headache mean? The patient's family was concerned about the overuse of pain medication and the dependency on shipments from Greece. For the patient the pain meant bodily suffering, but at the same time it meant an opportunity to reconnect with her native country through bimonthly requests for the desired pain reliever. Neither the family nor the patient herself seemed to be aware of the inner pain: the grief, loneliness, and fear of the uncertain future as the cause of the woman's headache. I, therefore, concur with David Morris who states: "An understanding of pain requires many kinds of knowledge, but the knowledge most consistently ignored or dismissed as I have claimed concerns the bond that links pain with meaning.,,3 
What did the headache mean in cases 2 and 3? Both young men had headaches that were medically identified as tension-type headache. Both denied work over1oad or grief; they were actively involved with friends and had goals for the future. "Why do we have headaches?" they asked. Both men suffered from conflicts between personal values and societal expectations, and the conflicts manifested in bodily pain. 
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The 58-year-old woman (case 4) suffered medically from chronic cluster headache. Her pain, however, meant much more. By listening to her story, one had to assume that she would be chronically depressed, feel shame and guilt about the fate of two children, and feel anxiety about the incapacitating pain. It depended on the physician's philosophy and skUI how she would approach such a complex problem. She could have addressed depression primarily as the cause of her chronic pain, which probably would have opened the gate to despair even further. She could have chosen solely the medical approach and treated the cluster headache with medication--personal issues could have been left untouched. One can only speculate about the outcome of such treatment regimen. 
The Role of the Human Spirit 
Frankl has changed the direction of modern psychology by introducing the human spirit as the third dimension to body and psyche.2 He emphasizes that the human being surpasses the animal because of this special element. The spirit differs from psyche and body because it cannot become ill. It can be overshadowed by emotional and bodily dysfunction, but, like the sun behind clouds, it is always present and ready to emerge. 
The medical profession and Western psychologists are trained to search for pathology and correct it if possible. This generally is acceptable and often helpful. However, in cases where there is chronic suffering and feeling of loss of control and unworthiness, one should not dig for the unhealthy. It reinforces the patients' conviction of Inadequacy. The physician, who believes in a healthy core In each individual, meets her patients on this level. For instance, she encouraged the 58-year-old woman (case 4) to allow a glimpse at her personal concerns. This was not done to find more evidence for dysfunction. It served the purpose of discovering coping ability and survival skills. This woman needed an affirmation of her dignity. When she was admired for her strength, she responded with a new vitality and readiness to move on. It also made her headache cease. 
In cases 2 and 3 (the young man involved in anti-racial demonstration and the student with a homosexual experience) the physician by-passed the emotional side of their experiences and reminded them of their power of decision making. They had the freedom of adhering to traditional values or forming their own; to follow rules or act according to their conscience. 
The Greek woman (case 1), who suffered from grief, and uncertainty about her health and her future, became aware again of her supportive and loving son and his family who had taken her into their home. She recognized also 
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her own responsibility for influencing her headache by letting go of nostalgic pain treatment with Greek aspirin. She certainly demonstrated during her second visit that she had regained control over bodily and emotional dysfunction and that her life had taken on new meaning. 
Summary 
The present paper demonstrates, with four case histories, the complexity of chronic headache. Medical diagnosis and categorization Is Insufficient In planning a treatment regimen. It seems more Important to Introduce the concept of the "meaning of pain.· By raising the question of what the pain might reflect, one shifts from medical diagnosis to complex cause. This approach fosters a new understanding of the Inter-relationship of body and mind. It also opens the door for patients to participate In their evaluation and their treatment plan. 
The patient's capacity for Insight and decision-making ls contributed to their human spirit. The case histories stress the Importance of addressing this healthy core. This enables the patient to step aside from the symptom of pain and to find new directions and meaning. 
INGEBORG VAN PELT [302 Amherst Rd., Pelham, Massachusetts 01002 U.S.A.] Is director of Health Services at Amherst College, Amherst, Massachusetts and a consultant at the John Graham Headache Center, Faulkner Hospital, Boston, Massachusetts. 
Referencn 
1. Cassel, E. (1982). The nature of suffering and the goals In medicine. The New England Journal of Medicine, 306, 639-645. 
2. Frankl, V. (1969). The will to meaning: Foundations and applications of logotherapy. NY: World Publishing Company. 
3. Morris, D. (1991). The Culture of Pain. Berkeley: University of California Press. 
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The International Forum for Logotherapy, 1994, 17, 76-81. 
LOGOTHERAPY: A JOURNEY INTO MEANING FOR PEOPLE WITH AIDS 
Gina Giovinco and Jackie McDougald 
In the summer of 1981, the Centers for Disease Control (CDC) in Atlanta, Georgia, briefly commented in their weekly newsletter on the unexpected occurrence of an unusual and often lethal type of protozoan infection of the lung (Pneumocystis Carini Pneumonia) in five young homosexual Los Angeles men. Some also had an even rarer form of disseminated cancer (Kaposis Sarcoma). In September of that year, investigators in New York City noted in Lancet that they had seen eight cases of Kaposis Sarcoma in young homosexual men. 6 
AIDS is a devastating human condition. It leads more rapidly to death than some of the traditional chronic diseases such as cardiac disease, hypertension, and certain cancers. People with AIDS (PWA) are compelled to make lifestyle alterations that are energy-demanding. Many people who have enjoyed productive lives professionally and personally find themselves in compromised situations that may lead eventually to no-thing-ness and boredom that is manifested in a lack of meaning in life (existential vacuum). The PWA who have found purpose and meaning in life, even in the crisis of AIDS, experience a longer, more productive, purposeful life. 
Since 1981, there has been progress as well as setbacks in understanding this dreadful and heart-rending disease. However, the present paper is not a clinical discussion of the medical management of PWA. This is a discussion that focuses on three such persons finding purpose and meaning in life through the principles of logotherapy. 
Applying Logotherapy to PWA 
The search for meaning is our primary motivation. The meaning is unique and specific in that it can be fulfilled by each person alone; only then does it achieve a significance that will satisfy that person's own will to meaning.4 
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Based on the undertylng assumptions posited by Crumbaugh,1·P·1 5-18 PWA can find meaning In life that gives them personal Identity and the feeling of being "somebody" rather than a number. The following steps are suggested in developing a meaningful counseling program for PWA: 
Step 1. Finding a basic approach to the meaning of life. 
Step 2. Finding a way to buUd self-confidence. 
Step 3. Finding a way to use creativity to Increase self-confidence 
through critical thinking. 
Step 4. Finding life-meaning through personal relationships 
(encounters). 
Step 5. Finding life-meaning through dereflectlon. 
The focus of this paper Is how the concepts of logotherapy can be helpful in working with PWA to determine meaning In their existence arid help them firld purpose In life. Emphasis Is placed on the moral integrity of personhood and how the concepts of logotherapy support the philosophy that Individuals are capable of transcending a dreadful human condition to firld meaning in life while suffering. 
Crumbaugh suggests two techniques that, when practiced consistently, enable discovery of meaning and purpose in life: a) Expanding Conscious Awareness, and b) Stimulating Creative Imagination. Expanding Conscious Awareness Is to become more aware of the wortd around us and what goes on In It along with what It means. 
The three Individuals discussed in the present paper exparlded. their awareness of the wortd around them, Including the many dimensions of human suffering, arid made discoveries about themselves they had been unaware of before AIDS. Their expanded conscious awareness enabled them to become "somebody" by accepting the challenge to live rather than die before the time for death came. Their creativity in developing new life-styles utilized creative Imagination they had been unaware of previously. 
The three individuals came to our attention from interaction with a local AIDS support group. All three had been diagnosed more than five years earlier. For the most part, they were still healthy and their energy level remained high. We asked ourselves: "What makes the difference between these PWA and others In the same situation?" The more we shared values and beliefs about life and listened to these individuals and others, the more we became convinced that logotherapy concepts can provide a basis for counseling PWA. The positive attitudes of these three individuals were compelling to us. There were similarities in their stories and Dr. Frankl's story in Man's Search For Meaning. So, It was for this reason we began to look at 
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these individuals and compare them with other PWA in the group. What was the difference in these three individuals and the others who were not doing well. We connected the positive lives of these three people with the philosophy of logotherapy. 
The Purpose-In-Life (PIL) test and Seeking of Noetic Goals (SONG) test were completed by each of the Individuals presented in this paper. The PIL test measures the degree to which individuals experience life as meaningful, how much they feel like "somebody that matters,• or how strongly they have developed a sense of purposeful direction in life.1•5 The SONG test is an attitude scale designed to measure the individual's level of motivation to discover life-meaning/purpose. 
D.M. 
scored 120 on Part A of the PIL Scores of 112 or more indicate a definite purpose in life. O.M. indicated on Part A that he had very clear goals in life, that his personal existence was very purposeful and meaningful, that he always saw a reason for being, and that he had discovered clear-cut goals and a satisfying life-purpose. High scores in all of these items fit with how 

D.M. 
described his aims, ambitions, and goals in life in Part C of the PIL In his own words: "My main aim in life now is to help to educate the Christian community about AIDS and addictions...! have seen God change th1i situations in the church before my eyes. Sometimes it amazes me. My local congregation is my best support group. I believe God can do this nationwide. I realize it's not for all afflicted, because they don't have any desire to change. However, I know many that have wanted to and have been rejected. My goal is to live to see this change take place in the Church. They have a responsibility to Jesus Christ. Someone has to remind them. I thank God He has seen fit to use me in this regard.· Part B of the PIL was used, in this incidence, to help the therapist determine the consistency in how D.M. personalized his goals. D.M.'s completion of the open-ended sentences of Part B was consistent with Parts A and C and indicated a strong aspiration of seeking a ministry in life. For example, for item 5 (which asks for a person's highest aspiration), D.M. answered: "My highest aspiration Is to glorify God and help others who are presently living where I was three years ago.· This meaningful theme was evidenced throughout not only the PIL but also the life-style of 

D.M. 
He scored 77 on the SONG. The PIL and the SONG gave the therapist valuable insight into supporting D.M. to live a meaningful life and affirming him as "somebody who matters.· 


J.G. scored 135 on the PIL. He had strong feelings that he could make a difference in life by helping others and thereby helping himself. This gave him a goal in life and helped him achieve the feeling of being "somebody that 
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matters" and has a direction In life. He scored 61 on the SONG. Although J.G. did not complete Parts B and C of the PIL, responses in Part A were significant In relation to the changes in his life since he chose to live. He was exuberant and enthusiastic. He had very clear goals and aims and found his life purposeful and meaningful because he discovered a new meaning and discovered creative abilities of which he was unaware before he developed AIDS. He Indicated that he would choose nine more lives just like this one. He had plans to do some of the exciting things he always wanted to do but could not find the time or motivation. He felt more responsibleness, and felt he became somebody who mattered to himself and others because he became more aware of people and human suffering. J.G. found a reason for being; he faced daily tasks with enthusiasm and satisfaction. His goals became clearcut, and his life felt under his control. J.G. was aware that death is a reality, but he was prepared and not afraid. 
J.L. 
scored 129 on the PIL. He had found a purpose in life through the study of Eastern Religion, Transcendental Meditation, and Christian Science. 

J.L. 
indicated that although everyday was about the same, he felt enthusiastic and his life was more exciting because he had developed clear goals and aims in life. He had discovered much about himself and had become more aware of human suffering. Therefore, he found his life to be purposeful and meaningful. Life for J.L. was not all work or all play--he had balance and was doing some of the things he had always wanted to do. He felt his life to be worthwhile. He felt a reason for being. Doing things for others helped him to feel like a somebody with something worthwhile to contribute to the goodwill of others. J.L. believed himself a very responsible person, freed from nothingness, and able to make more creative life choices and face daily tasks with pleasure and satisfaction because he had developed more clear cut goals. In the past, J.L. thought about suicide as a way out of his situation, but then he developed control of his life, living life purposefully. He was aware death would come, but he was not afraid to die. In his own words: "I feel we are put on Earth to meet our Karma and to fulfill and achieve perfection. We must go through negatives and positives. For all the positives we must have negatives. You must experience all emotions." He scored a 98 on the SONG. 


We also invited three members of the group who were not doing very well to take the PIL and SONG. These individuals produced the following scores: 
a) 70 on the PIL, 29 on the SONG; b) 67 on the PIL, 50 on the SONG; c) 79 on the PIL, 65 on the SONG. Combined use of the two scores were helpful in determining the probability of successful therapeutic intervention with individuals in the group and in individual counseling. 
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Concluding Remarks 
Although our sample is small, we believe we have the basis for a larger investigation of counseling programs and approaches for PWA and their significant others. We believe that Individuals can be identified as having low purpose in life by using pre-post-test methods. 
Specific logotherapeutic methods that are used depend on the client's life situations and the skill of the counselor. One method we begin with was self-discovery. As Fabry stated: "Logotherapists make patients conscious of what they already know. That they are first and foremost human beings with the capacity of finding meaning: only secondarily are they individuals who have certain shortcomings which can be overcome, and unwanted patterns which can be broken . ..2. p.,o "Most individuals [in a group] are motivated In an atmosphere of caring and by the example of other members who have overcome a problem they are struggling with. Together they explore the truths about themselves, their choices, their uniqueness, their responsibleness, and the outreach beyond themselves . .,:i, P· 1 57 Fabry also says that "ideally logotherapy, with its emphasis on personal uniqueness and individual responsibleness, is based on a relationship between two human beings, the counselor and the client. It is the task of the counselor to motivate the client to search for meaning and provide opportunities for him to select new ways of finding meaning through the doors the counselor opens. •3• p.e, 
As stated earlier in this paper, people who are struggling with a life-threatening condition tend to live longer when they have a purpose in life, have feelings of belonging, and feel they are "somebody." They also tend to develop a sense of responsibleness rather than taking on the role of victim that may lead to more intense self-destructive behavior such as drugs and alcohol. 
GINA GIOVINCO, R.N., PH.D., ED.D, [7727 Southwest 11th Avenue, Gainesville, Florida 32607 U.S.A.) is associate professor of nursing at the University of Central Florida, Orlando, Florida U.S.A. and a diplomata in logotherapy. 
JACKIE MCDOUGALD, R.N. was coordinator of testing & counseling, AIDS Program, Orange County, Orlando, Florida U.S.A. when this article was written. 
80 
References 
1. Crumbaugh, J. C. (1973). Everything to gain: A guide to self-fulfillment. Chicago: Nelson Hall. 
2. 
Fabry, J. (1979). The noetlc unconscious. The International Forum for Logotherapy, 2, 8-11. 

3. 
Fabry, J., Bulka, A. P., & Sahaklan, W. S. (Eds.). (1979). Logotherapy In action. NY: Jason Aronson. 

4. 
Frankl, V. E. (1984). Man's search for meaning. NY: Washington Square Press. 

5. 
Hutzell, A. A. (1988). A Review of The Purpose In Life Test. The International Forum for Logotherapy, 11, 89-101. 

6. 
Levine, C., & Bermel, J. (1985). AIDS: The emerging ethical dilemmas. The Hastings Center Reports, 15 (4), 1-32. 


NEWS ABOUT VIKTOR FRANKL 
Frankl, nearing his 90th birthday and severely handicapped by very poor sight, still has a full schedule for the fall. 
1. 
A public lecture at the University of Munich. 

2. 
A presence at the dedication of a newly established Viktor Frankl Chair for Philosophy and Psychiatry at the University of Liechtenstein In Schaan. The following day he will present a Question-and-Answer session at the Liechtenstein Academy of Science. 

3. 
A lecture at the University of Graz (Austria) before a professional and medical audience on the "Prevention of Suicide • Differential Diagnoses and Psychotherapy for Depressions.• 


He also received the coveted Goethe prize this year and gave an acceptance speech. 
LOCATION: DATE: PURPOSE: 
CONTACT: 
PROPOSED INTERNATIONAL GATHERING OF LOGOTHERAPISTS IN 1996 
Goteburg, Sweden May, June -to be determined Gathering would consist of plenary sessions, presentations of papers, current research and discussion. Inquiries for the purpose of determining interest are requested. John Stanich, Swedish Institute of Logotherapy, Box 13086, $-402 52, Goteburg, Sweden. Phone or Fax: lnt+~1-26 48 50 
81 
The International Forum for Logotherapy, 1994, 17, 82-86. 
LOGOTHERAPY IN SCHOOL CRISIS SITUATION 
Bianca z. Hirsch 
A school psychologist is faced with many situations that demand on-the-spot counseling. This article relates to two crisis situations in which the principles of logotherapy were used. Both cases dealt with the grieving process, the first on a school-wide basis, the other with the grieving by an individual child. 
Logotherapy maintains that, in addition to our physical and psychological dimensions, we possess the specifically human dimension of the spirit, and that all three must be addressed in a given situation. "Our human dimension enables us to reach beyond ourselves and to make meanings and values an essential part of our existence. Life has meaning under all, even the most miserable, conditions. We possess a deeply rooted conscience that helps us find the specific meanings in our unique life."1' P·19 Although life has meaning under all circumstances, it is up to each of us to find it as we move through life's daily trials and experiences. We make meaningful choices, have meaningful experiences, and discover meaningful attitudes in circumstances we cannot alter. 
When death is the creator of tragedy, we cannot go back and invent a meaningful situation. Tragedy affects different people differently. In elementary school, many of the children have not experienced the loss of a loved one. When tragedy occurs, pain and fear must be acknowledged and dealt with in a sympathetic manner. In the process of life, many painful situations occur, and each event can become a cornerstone for building a foundation of strength to handle future events. By Frankl's definition, "despair is caused by suffering in which the sufferer sees no meaning. Suffering in itself has no meaning, but we can assume meaningful attitudes toward events that in themselves are meaningless."1' P-47 

82 
In the first case a child was run over In front of the school, a situation that created unavoidable suffering. No grieving could change the blow that fate had handed out. Frankl stresses that life Is transitory. In the past, nothing is irrecoverably lost, but everything Is Irrevocably preserved. Nothing and nobody can deprive us of what we have rescued Into the past.2 In the face of the transitory aspects of life, we are responsible for using the passing opportunities to actualize potentials to realize values, whether creative, experiential, or attitudinal. Once we have realized a value or fulfilled a meaning, we have fulfilled it forever. In the physical dimension, we cannot bring back the dead. In the psychological dimension, we can deal with grief, and in the spiritual we can tum that grief Into meaning. 
In the second case the challenge was to help a youngster change his attitude toward a tragic event, thus enabling him to find meaning. 
A School-Wide Tragedy 
When a father came to pick up his first-grader after school, he parked on the opposite side of the street and signaled him to cross within the pedestrian zone, not noticing a car as it came around the corner. Willy was killed as he ran across the street. The tragedy deeply shocked and grieved the school personnel, parents, and children. As a school psychologist, together with the principal, we developed a plan to deal with the incident to help the children and their families through this tragedy. 
1. 
A general assembly of the student body was called where the principal spoke about the accident, expressed his personal grief and that of the staff, and acknowledged the fear and grief the children had experienced. He reviewed the safety rules, making sure not to imply that safety Issues had been overlooked. He then asked the teachers to return to their classrooms and hold further discussions with the children. This step still remained on the physical and psychological levels, acknowledging existing feelings and providing opportunities to discuss them further in smaller, safe, and familiar surroundings. 

2. 
Anyone from the school who chose to go to the funeral (the children with parental permission), was given time off, and transportation was arranged. This step, still largely in the psychological dimension, offered a first glimpse that, although the tragic accident had to be accepted, there were choices. 

3. 
Within each classroom the teachers encouraged the children to express their feelings of sadness and tell about specific activities or incidents they remembered about Willy. This allowed the children to 


83 
work through their feelings about the tragedy while distancing themselves from the harsh reality, and focus on positive experiences with Willy in the past. In this phase we entered the domain of the human spirit. 
4. 
If a desire was expressed by a class, a memento was sent to Willy's family--an illustrated story or a photograph of some activity in which Willy had participated. This used the children's creativity to face positive sides of reality which retroactively elucidated meaning. 

5. 
To help them find closure to the tragic incident, the children were 

, encouraged to write down their thoughts and draw pictures of happy Incidents they had shared with Willy. These writings and drawings were bound Into a booklet and sent to Willy's parents. 

6. 
Some of the children attended the funeral, many did not. After the funeral and the sending of the memento, regular classroom activities were resumed, except for children still showing excessive grieving who were encouraged to seek counseling. This focused attention on the future instead of hyperreflecting on past tragedy. 


The principal held another assembly the day after the funeral, again sharing his and his staff's grief. He encouraged the teachers to take time In the classrooms to discuss with the children what they had learned from the incident, Including their awareness of safety rules and their own safety. 
The notes and reflections became meaningful mementoes of happier days for Willy's classmates and his parents. 
A Family Tragedy and Personal Triumph 
In the other Incident, parents had an only child--elght-year-old Eddie. They wanted another child and Eddie urged them to give him a little brother. Although it was financially difficult, they had another boy, unfortunately severely disabled. Stevie required around-the-clock care and enormous amounts of money (at one time the father said he owed $120,000 just In medical bills). Mother and father did all they could to care for the infant, and thus spent little time with Eddie. 
Eddie, too, helped with the baby and was deeply devoted to him. The family moved to a larger city to get better care for the infant, thus Eddie was uprooted and had to cope with a new environment, a new school, and a loss of his friends. He did not always come to school well groomed, and often looked sad and for1orn. His school work deteriorated and the teachers became concerned. In spite of all efforts Stevie died In his second year. When Eddie returned to school, he was downcast and deeply unhappy. When he came 
84 
to my office, he poured his heart out. He said he often was so sad that he could not pay attention In class because all he could think of was his little brother and how much he loved him. 
We spoke about the love and care and devotion his parents and he had provided for the baby, and how wonderful that child must have felt being surrounded by three caring people. We also spoke about all the medical interventions that had been necessary, how difficult It had been for little Stevie just to breathe, eat, and feel comfortable, and how much pain he must have endured. 
I then asked Eddie what the baby had given him. He looked at me quite perplexed, and said the baby never really interacted with him because It was blind and deaf, and often just cried endlessly. This was an opportunity to help Eddie find new attitudes about the situation. His answers to my questions showed how much this eight-year-old had matured through his painful experience. Here Is what we discovered: The baby gave Eddie an understanding that parental care and attention to Stevie came before attention given to Eddie. He therefore made no unnecessary demands on his parents so they could focus on Stevie. Intuitively Eddie saw this piece of self-transcendence as a gain. In a further expression of self-transcendence, Eddie held the baby, diapered and fed him to relieve his parents. These self-chosen responslbilltles made him feel good about himself. He loved the baby, played with him, and cuddled him--an experience of unconditional love which Eddie unconsciously experienced as a•g1tt.· He felt responsible to get home after school and be with his mother and baby--fulfilling a meaning rather than gratifying the pleasures of leisure. 
Stevie's disabilities and Eddie's ardent wish to help him gave Eddie an incentive to inquire about health and wellbeing and he began to wonder about his own future--perhaps to become a doctor. In logotherapeutic terms we could say that his attention shifted from the tragedy to what he could learn from It. 
We also talked about the fact that Stevie had shown his parents how proud they could be of Eddie because of his dependability, thoughtfulness, and sense of responsibility. In closure, we reviewed the past two years, giving attention to Eddie's achievements which no one could take away from him, and his love for Stevie that remained beyond his grave. 
Eddie left my office with his head high. He later wrote this poem: 
85 
Stevie, I loved you then--1 love you still. I hope you have gone to a better life. I hope you wlll not suffer anymore and that you are at peace. 
You taught me to be kind, you taught me to be thoughtful, and I will never forget you for that, I will love you always. 
Eddie. 
I copied this poem and had it framed. These words are now hanging on the wall, near Eddie's desk, reflecting the feelings of his heart. 
BIANCA Z. HIRSCH, Ph.D., [115 San Anselmo Avenue, San Francisco, California 94127, U.S.A.] is a psychologist with the San Francisco Unified School District, an associate professor on the clinical faculty of the University of California Medical School In San Francisco, and past president of the Viktor Frankl Institute of Logotherapy. 
References 
1. 
Fabry, J. B. (1968). The pursuit of meaning. Boston: Beacon Press. 

2. 
Frankl, V. E. (1969). The will to meaning. NY: World Publishing Company. 


86 

The International Forum for Logotherapy, 1994, 17, 87-92. 
USES OF HYPNOSIS IN LOGOTHERAPY 
R. R. Hutzell and Jim Lantz 
Hypnosis can be defined as the art of securing a client's attention and then effectively communicating ideas to enhance motivation and change perceptions.6 Some authorities believe that hypnosis always Includes hypnotic trance development,7 while others define it as any effective treatment relationship, with or without trance phenomena.5 In our work, hypnosis does include the specific development of a trance that client and therapist utilize together to help the client focus attention in a therapeutic direction. 
Approaches to Hypnosis 
There are three major approaches of hypnotherapy: authoritarian, permissive, and self-hypnosis. In the authoritarian approach the therapist does hypnosis to the client. The therapist is forceful, directive, charismatic, and strategic.6 The client is considered an object of intervention. In our view, the authoritarian approach is not compatible with the values of logotherapy. It does not fit with Frankl's view that: 
Within the framework of psychotherapy, the methodology and technique applied at any given time is least effective at all; rather it is the human relationship between physician and patient which is determining.3' p. 468 
In the permissive approach, also called the cooperation or the metaphorical approach,4'6 the therapist uses hypnosis with the client in an 
87 
interactional, respectful, and cooperative manner. The therapist does not force a trance on the clients but rather helps them develop the level of trance they feel will be helpful. The permissive approach is compatible with the values of logotherapy because it does not disrupt the clients' sense of freedom or responsibility and treats them as persons to encounter rather than objects to be manipulated. 
In self-hypnosis, the therapist teaches clients how to use hypnosis independently to Increase concentration and relaxation, to control symptoms, and to Increase their sense of mastery and control.8 Self-hypnosis also is compatible with logotherapy as It does not decrease the clients' sense of responsibility, freedom, and control. 
Induction Stages 
456
There are many methods of helping clients develop a hypnotic trance. '' One method often used In the permissive approach includes six stages: a) obtaining permission from the clients to help them move into a hypnotic trance, b) helping them relax physically, c) providing them mental imagery of deeper relaxation, d) helping them deepen the trance, e) helping them accept suggestions and metaphors that can enhance their chances of achieving their 
456
treatment goals, and f) ending the hypnotic trance. ' ' 
Hypnosis in Logotherapy The function of the therapist In logotherapy is to help clients gain awareness of the meanings and meaning potentials in their lives and to help 
59 10
them take action to make use of these meanings and meaning potentials.2• • • Hypnosis can be used in logotherapy as an adjunct to treatment by: a) helping clients control or gain distance from symptoms that block meaning awareness, b) helping them bring repressed meanings and meaning potentials into conscious awareness, and c) helping them concentrate more effectively while taking action to make use of the meanings and meaning potentials in their lives. 
Symptom Control to Free Blocked Meaning 
Clients can be taught to modify symptoms (and to distance themselves from the symptoms) that originate in their physiological or psychological dimensions and block meaning awareness. Hypnosis can be a useful tool in such symptom control as the following case illustrates. 
Mr. Smith was referred for hypnotherapy by his physician to help decrease and learn to live with chronic back pain. Mr. Smith had suffered a serious 
88 
back injury in an auto accident. He had gone through surgeries, yet had found only minimal pain relief through medications and other medical treatments. He reported that his back pain disrupted the "enjoyment in my life" and disrupted his ability to focus upon activities and interests that he considered to be "meaningful." Mr. Smith scored 91 on the Purpose-in-Life (PIL) test1 at the start of treatment, indicating that he was suffering an existential vacuum (reactive to his back pain). He was highly motivated to learn to use hypnosis to control his back pain. He was able to accept a number of suggestions and metaphors while in deep trance that he could use to moderate his pain. He reported that his new ability to "control my pain" allowed him to rediscover "much of the meaning in my life.· He was proud of how he had learned to •overcome my pain.· At the end of treatment Mr. Smith scored 123 on the PIL test. 
An example of how hypnosis can be used to reduce a symptom originating in the psychological dimension is the case of Mr. D. Due to a long history of extreme abuse during childhood, Mr. D had developed an alter personality. The alter personality appeared very Independent, uncaring, and sociopathic. Mr. D, on the other hand, had a family and other persons he cared for very much. As a part of ongoing psychotherapy, hypnosis was used to create a "trial fusion• of Mr. D and his alter personality. Without the symptom of a split In the personality, the alter was able to be aware of blocked values of family, people, and other self-transcendent Issues. The alter was able to retain awareness of these values even after the trial fusion was ended. As a result, the alter discontinued the sociopathic behaviors that previously had severely interfered with the desires of Mr. D to actualize selftranscendent values on a consistent basis. 
Bringing Meaning and Meaning Potentials to Awareness 
Since hypnosis is an excellent method of helping a client focus attention and reframe perceptions, it can often be used In logotherapy to help a client gain awareness of meanings and meaning potentials that have been covered, clouded, or repressed. The hypnotic trance can be used to focus the clients' attention on the meanings and meaning potentials contained in their noetic unconscious. 
The following trance-metaphor is one example of how hypnosis is used to bring repressed meanings and meaning potentials Into conscious awareness. This metaphor should be used in stage five of the previously described induction steps. (Note: The following material does not include the repetition 
89 
(of words and phrases) used in actual practice. This metaphor, called the 
"Flood" or the "Mud" metaphor,9 is used after trance development. 
An Appalachian family lived at the bottom of a hill next to a river. In 
the spring when the snow melts and the rains come, sometimes the 
river would overflow and there would be a flood. We all have some 
floods In our lives. When the river flooded, the family would go up 
the hill to grandmother's house and wait for the waters to go down. 
The waters always do go down. After the flood the family would go 
back to their home to look at the damage. The house would be 
covered with mud which would also cover up the family's valuables. 
The family members would say that the flood left them with buried 
treasures. We all have some buried treasures in our lives. After the 
flood all the family members would make friends with a shovel and 
would work and work to recover their buried treasures. This is the 
way life is. Sometimes the floods in your lives give you buried 
treasures--things that mean a great deal to you or could mean a great 
deal to you. Buried treasures are covered by the floods in your life. 
But you will uncover them. You will find your buried treasures; the 
meaningful buried treasures in your life. 
The use of hypnotic dreams or hypnotic movies often is helpful to allow 
the noetic unconscious to reveal meaning and meaning potentials. Mrs. S had been depressed for years; recently she became suicidal. Psychotherapy designed to directly reduce symptoms was not helpful. Hypnosis was conducted in cooperation with Mrs. S, with instructions to "have a movie from deep within that will provide you with information as to what will be the most meaningful thing for you to do in order to reduce your depression." Mrs. S's movie revealed that she needed to grieve for her child that had been born dead 13 years earlier. She had not been allowed to grieve at the time of the birth, and later she had suppressed the memories of the birth. Following this hypnosis, she was able to grieve the loss of her child and then put her energy into other living children. Her depression lifted quickly and did not return after extensive follow-up. 
Concentration for Taking Action 
Another way that hypnosis can be used in logotherapy is to help clients concentrate and focus more effectively on making use of the meaning potentials they have identified. Mr. K had smoked three packs of cigarettes per day for 30 years. He had attempted to quit many times, without success. In light hypnosis, and with permission of Mr. K, mental movies of "lighting up 
90 
behaviors" and "reasons (meanings) for not smoking" were intertwined; then mental movies of "every act of choosing not to smoke" and "meanings of being a non-smoker" were Intertwined. The client stopped smoking. He reported that, as a result of the hypnosis, he could more clearly remember his meaning behind not smoking, whenever he did anything that previously would have led up to smoking. He also reported that he could remember more clearly the meaning to him of being a non-smoker, and this helped him to continue to say no to cigarettes. 
Several books of suggestions and scripts are available that the logotherapist can adapt to help clients concentrate and focus more effectively on meaning potentials. Hamond has a wonderful collection of hypnotic suggestions and metaphors that can be used by clients and therapists to help clients lead more effective and meaningful lives.6 
Warning 
It is not difficult to learn to do hypnosis poorly, but it is very difficult to learn to do it well. The fact that bad hypnosis is easy to learn means that many people practice hypnosis in a way that gives this form of therapy a bad reputation. 
From the logotherapy perspective, hypnotherapy should not be manipulative, overly dramatic, reductionistic, and disrespectful to the client. Competent hypnotherapy by the logotherapist is humanistic and respectful; and it enhances the client's sense of responsibility and will to meaning. 
Logotherapists interested In learning to use hypnosis may contact either The American Society of Oinical Hypnosis, 220 E. Devon Avenue, #291, Des Plaines, Illinois 60018, USA or the Society for Clinical and Experimental Hypnosis, 128A Kings Park Drive, Liverpool, New York 13090, USA. Both organizations are well respected, set high standards, and offer hypnosis training programs and opportunities. 
ROBERT R. HUTZELL, Ph.D., [P. 0. Drawer 112, Knoxville, Iowa 50138, U.S.A.] diplomate in logotherapy, is a clinical psychologist at the VA Medical Center in Knoxville, Iowa and director of psychology at a multi-specialty medical clinic in Knoxville. 
JIM LANTZ, Ph.D., [Worthington Logotherapy Center, 6641 High St., Suite 200, Worthington, Ohio, 43085, U.S.A.] diplomate in logotherapy, is associate 
91 
professor In clinical social work at The Ohio State University, and director of the Worthington Logotherapy Center. 
References 
1. 
Crumbaugh, J., & Maholick, L (1969). The Purpose in Life Test. Murfreesboro: Psychometric Affiliates. 

2. 
Frankl, V. (1955). The doctor and the soul. NY: Vintage Press. 

3. 
Frankl, V. (1964). The Image of man of psychotherapy. In M. Freedman (Ed.), The worlds of existentialism. London: Humanities Press International. 

4. 
Hadley, J., & Staudacher, C. (1989). Hypnosis for change. Oakland: New Harbinger Publications. 

5. 
Haley, J. (1973). Uncommon therapy: The psychiatric techniques of Mikon H. Erickson. NY: W. W. Norton. 

6. 
Hammond, C. (1990). Handbook of hypnotic suggestion and metaphors. NY: W. W. Norton. 

7. 
Howard, L, & Reardon, J. (1986). Changes in the self concept and athletic performance of weight lifters through a cognitive-hypnotic approach: An empirical study. American Journal of Clinical Hypnosis, 28, 


248-257. 
8. 
Lantz, J. (1993). Existential family therapy: Using the concepts of Viktor Frankl. NY: Jason Aronson. 

9. 
Lantz, J., & Harper, K (1992). Stories and tales in logotherapy with urban-appalachian families. Contemporary Family Therapy, 14, 455-466. 

10. 
Lukas, E. (1984). Meaningful living. Cambridge:Schenkman Publishing. 


92 
The International Forum for Logotherapy, 1994, 17, 93-95. 
SELF-TRANSCENDENCE IN THE SCHOOLS 
Moshe Addad 
A school that understands the true existential needs of Its students, and strives to meet those needs, will succeed in motivating Its students toward a meaningful, fruitful, continuous learning process. Such a school offers opportunities for self-discovery, choices, uniqueness, responsibility, and selftranscendence--all of which are human capacities listed by Frankl as resources of the human spirit. 4 The present article focuses particularty on the place of self-transcendence In the learning process. 
Unfortunately, too much emphasis has been placed on our capacity for self-actualization. As Frankl points out, actualizing one's potential Is a mixed blessing. He quotes Socrates who said there were many resources within him, including the tendency to become a criminal. Had Socrates actualized this tendency, he would have turned Into a criminal Instead of a great teacher.5 Frankl points out that self-actualization is an asset only if It Is directed toward logos (meaning, spirit). 
Developing Resources of the Spirit 
Can we, through the use of the school, awaken In students the spiritual resources Inherent in them, so they can reach self-transcendence? I believe we can. But it depends on the teachers, their own awareness of the importance of their spiritual resources, and the extent to which they are ready to invest their efforts, planning, and thoughts. Teachers must do more than just use their teaching materials, give exams, assign grades, and carry out the minimal functions of their calling. They must look for spiritual satisfaction in their work, stemming from all their actions as human beings, their humanity, their love for their students. They must not look for just their professional success. They must discover joy in their unique contribution to the mental, spiritual, and academic development of their students. This is the way to 
93 
arouse the resources of their students and support their own •1• and the 
'Thou" of their students.1•2•3 
Teachers must plan and prepare classes In a way that will permit human and meaningful activities, accompanied by respect of the students as human beings. They must offer students challenging opportunities, that wUI prompt them to human activities within their studies (work in groups) and outside (volunteer work outside the school). The various learning topics (referring to approaching holidays, personalities in the news, historical events) should turn Into discussions demanding personal involvement of the students. They should be given opportunities to try their hands at the execution of various tasks, demanding social obligations and personal responsibility--for Instance, taking part in social, national, and even political events. This can be accomplished by study of the subject, exposure to contradictory opinions, and class discussions. These activities can partially take place in the students' free time (afternoons, vacations). 
The learning frame must go beyond the opportunity for students to learn facts and to derive the results of selfish success. Focussing on egotistic success alone does not give the feeling of expanding the •1•. In the long run, it is not exciting and may turn students Into collectors of successes. When successes don't always come, there Is an anxious fear of failure. Selfcenteredness prevents the students from seeing the horlzon--the expanse. 
The Frame of School 
Often schools see learning as just a means to reach other alms, such as a future profession, social standing, or money. This type of learnlng--leamlng not for Its own sake--cannot supply self-transcendence. 
We must see the frame of school as a frame of life In the present and future, holding potential for reaching everyday aims and more, which lay the foundations for the students' spirituality. Learning facts Is important In our changing world, but it Is not enough. We must enable our children to live values; to actualize and experience values. Teachers must develop a life of meaning and purpose so they can be a model for their students. If teachers honestly believe in the Ideals about which they talk to students, they shall project their spirit to them. 
Students have a spiritual thirst that lies deep within them. If teachers don't pay attention to this thirst, they prevent students from quenching It. Students will go in their footsteps and suppress their thirst, side-stepping It until they tum Indifferent to It. 
94 
We must not let students become indifferent. We must encourage their spiritual thirst and search for possible ways to nourish and quench it. If we teach students only the task of passive listeners, of "grinders• of information that comes from our mouths, we educate and adapt them to indifference, lack of involvement, and dullness. They will get used to being onlookers of life's vistas without feeling the need to take an active part, like TV viewers. The learning routine of one-sided learning from the teacher's mouth to the students' ears will conquer the students' spirituality. 
The spirit of the students, like the human spirit In general, represents the human yearning for valuable tasks, ideas and ideals, faith and fantasies, love above the physical, a conscience beyond the superego, self-transcendence, moral uniqueness, and freedom of choice toward meaningful goals.3 This spiritual dimension inhabits everyone. It awaits realization. 
Aiming at self-actualization, as such, is a dangerous musion. It pushes us to the pursuit of more and more whUe losing our aliveness. More important than self-actualization Is the teaching of students to discover their innate resources and actualize those that will bring meaning and strengthen their spiritual dimension. 
The race for matriculation, or any academic certificate, is worthless in itself, unless It is part of the main goal--education to responsibility, to meaning, to develop the spiritual dimension in addition to the psychological one. Only through the spiritual dimension can we sense the truth of having been made "a little lower than the angels.· The spirit that dwells in us needs discovery and nurturing. Schools must accept this task. 
MOSHE ADDAD Is professor In the criminology department, Bar-llan University, 52900 Ramat-Gan, Israel. 
References 
1. Addad, M. (1987). Neuroticlsm, extraversion, and meaning of life: A complete study of criminals and non-criminals. Personality and Individual Differences, 8, 879-883. 
2. Addad, M. (1989). Moral judgment and moral behavior. Studies in education. Haiffa University Press. 
3. 
Addad, M., & Benetech, M. (1987). Extraversion, neuroticlsm, and delinquency. L'Evolution Psychiatric, Edition Privat, Toulouse, Paris, 52, 703-717. 

4. 
Fabry, J. (1968). The pursuit of meaning. Berkeley: Institute of Logotherapy Press. 

5. 
Frankl, V. (1967). Psychotherapy and existentialism. NY: Simon & Schuster. 


95 
The International Forum for Logotherapy, 1994, 17, 96-101. 
RETHINKING LOGOTHERAPY TRAINING NEEDS 
Grace Kannady 
Since the 1950's when Man's Search for Meaning was introduced to American readers,4 and the 1970's when the United States logotherapy training program was designed, the social context of the United States has changed enormously. The community now has taken on global dimensions and information is the commodity of cultural exchange.2 Education is no longer complete with a high school or college diploma but is now life-long.9 Families, once nuclear, are now highly diverse in structure and size, posing new challenges.7 Our median age is no longer young adult but middle age. 13 We are rapidly becoming a mosaic society, and pluralism is overtaking assimilation as the preferred method of dealing with diversity.8 The roles and status of women and minorities have changed.8 The American Dream of creating a successful, comfortable lifestyle is becoming more elusive for our children, and the gap between the haves and the have-nots continues to widen.1 Thus, the social context of logotherapy training has indeed changed. 
A Survey by Questionnaire 
In 1993 the Mid America Institute of Logotherapy decided to undertake a project to gauge just how much change had taken place In the training needs of its community. The purpose was twofold: a) to gather demographic information on who was currently interested in training, and b) to listen to those interested persons as to what their needs were in terms of training. A survey was designed that consisted of a four-page questionnaire mailed to the 392 persons who constituted the mailing list of the Mid America Institute of Logotherapy. Fifty-five individuals returned their survey representing a 14% return. 

96 
Results 
Demographic information included occupation, years in occupation, formal education, sex, and ethnic heritage. Eight occupational clusters emerged from the data: a) Ministry (18.2%), b) Counseling (16.4%), c) Psychology (16.4%), 
d) Social Work (16.4%), e) Education (12.7%), f) Medicine (7.3%), g) Writing (3.6%), and h) Other (9.0%). The total range of years spent In occupation ranged from 1 to 49 years, with 42% of the respondents having been in their selected occupation for over 21 years. The formal education history of the participants showed the following completions: a) 5.5% had some college work, b) 47.3% had a master's degree, c) 40% had a doctorate degree, d) 3.6% had a medical degree, and e) 3.6 % were classified as other. Gender was fairly evenly distributed (49% male; 51% female). The ethnic heritage of participants included 89.1 % White, 1.8% Hispanic, 1.8% Asian Indian, 1.8% African-American/American Indian, and 5.5% no response. The demographic picture that emerges from this data is that of a highly educated, white, male or female with a long-standing career in the helping professions. 
Assessment of training in this survey included past training in logotherapy, initial contact with logotherapy, and preferred future training in logotherapy. Past nonformal training among the 55 respondents was distributed as follows: a) Self-study (48), b) Workshops or Seminars (37), c) Regional Conferences (35), d) International Congresses (31), e) Logotherapy Retreats (20), f) Book Study (19), and g) Church Group Study (1). Past formal logotherapy training was attended by the following number of respondents: 
a) Introductory Course (42), b) Intermediate course (31), c) Advanced Practicum (18), d) College or University Courses (19), and e) None (7). 
Over 15 different responses were gathered from the respondents on their initial contact with the concept of logotherapy. The reading of Frankl's books was the most cited example, representing 38.2% of the responses. The next most cited examples were: a) graduate and undergraduate classes (11 %), b) actually meeting with Frankl (9%), c) talking with friends and associates (5%), 
d) logotherapy institute courses (5%), and e) social work conferences (5%). 
Preferred future training in logotherapy included areas of study, types of future training, credit for future training, delivery methods for future training, and educational technology for future training. Most of the respondents (45) indicated that they desired professional training in logotherapy. They also were interested in other methods: a) self-study (30), b) educational classes through colleges and universities (22), and c) specific logophilosophy courses (14). One individual wished for corporate education. Two were not interested in future training. 
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In terms of types of future training, 25 of the respondents were interested in formal training (Introductory, Intermediate, Advanced Practicum) and 25 were interested in nonformal training (self-directed study, study groups, and community noncredit courses). Eleven of the respondents were not interested in either kind of training. Three desired training beyond the Diplomate level. 
Responses for types of credit desired for future training were as follows: 
a) Certification (23), b) CEU's (17), and c) Graduate Credit (5). Twenty-two of the respondents indicated they were not interested In receiving such credit for future training. 
The top preferences for delivery methods were training courses adjunct to conferences and time-intensive training courses. The top preferences for educational technology were videotapes of logotherapy techniques and videotapes of leaders in logotherapy. 
The survey also included open-ended questions about the present training efforts in logotherapy in the midwest and suggestions for improvements. The following quotations are representative of these comments: 'We need to broaden the scope, include techniques for spreading logophilosophy.• 'We need an intermediate level of educator or practitioner.• "Availability and access needs to be expanded.· "Need to learn more therapeutic techniques, have the theory but need more practical application.· "Offer more introductory courses and awareness training opportunities for the public.· "Can't get away from my job to accomplish this, would like some Independent study which would count towards certification.• "Need training for personal application to one's own life.• 
Conclusions 
Emerging from these data are the competing themes of formalized study leading to legitimized professional certification and self-directed study focused on personal growth and development. Also inherent in these data Is the struggle between the present system of certifying only those with licensure In the helping or healing professions and the desire for a system that recognizes training for individuals without these credentials. Another disparity arising from the data is the strong desire of individuals for additional logotherapy training pitted against the complex demands and time restraints of their already overloaded professional lives. Voiced also was the repeating theme of theory versus practice--many respondents felt they understood logotherapy's basic concepts but lacked knowledge about how to transform those concepts into actual practice with clients or students. The data indicate a strong past commitment to training (both formal and nonformal). However, there was a 
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wide disparity in terms of future training, ranging from individuals who had no wish for further training to those who wanted training even beyond the Diplomata level. Overall, these data suggest a diversity of training needs. Even within the restriction of only 55 respondents, a wide variety of needs was made apparent. 
However, this diversity was not reflected in the demographic profile of the participants. One of the major findings of this article was one of omission. The United States is becoming increasingly diverse in Its religion, ethnicity, language, and social class. For example, It Is predicted that by the year 2000, one in three Americans will be a minority.12 Yet from the data collected from this Investigation, the audience for logotherapy seems to be highly homogeneous. Frankl's themes such as temporality and mortality, existential frustration and existential vacuum, and ultimate meaning, are certainly universal In their context.3'4 However, the data from this study do not reflect that all social classes and ethnic groups are involved equitably in the logotherapy community here in the midwest. 
Recommendations 
Based on the findings reported in this investigation, the following recommendations are offered. 
1. 
Training be offered through different iracks.• The present system of certification seems to be highly valued for those who want certification to practice logotherapy. In addition, other kinds of training and certification might be created for those who wish to disseminate logophilosophy. Examples might include those who work in gerontology, hospice, drug abuse, education, or the ministry. Such Individuals might, for example, work toward Certification as an Adult Educator In Logophilosophy. 

2. 
Training be offered through additional delivery systems and methods that utilize educational technology. Today's adult learner Is caught up in the often conflicting roles of family, work, education, and community and has limited time for pursuing personal learning interests. Educational systems throughout the United States have responded to this by offering distance-education courses, correspondence courses, teleconferences, subject-focused videotapes and laser discs, computer networks, etc. Training In logotherapy could incorporate such technology and widen its accessibility greatly. 

3. 
Training Incorporate the rich repertoires of experience of local logotherapy practitioners. For instance, simulated counseling sessions of the different techniques of logotherapy by practitioners could be 


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videotaped and used In training. Conference sessions could focus more on the actual practice of logotherapy. Training might even be enhanced by establishing mentorshlps between Diplomates and aspiring learners. 
4. 
Training expand even more Into the nonfonnal learning arena. For many, Frankl's message Is related to personal Inquiry and growth. More community classes, seminars, and book study groups would not only provide more opportunities for self-directed learning by those already familiar with Frankl but might also engage potential new learners. 

5. 
Training expand to Include a more diverse audience. Specific efforts seem Indicated to broaden the availability of training to different ethnic groups and social classes. One example might be logophllosophy noncredit community classes be offered through urban community colleges. Another might be the concerted effort to Include more people of color as key note speakers and session leaders at local conferences. 

6. 
Because of the suggested two-track training, a comment by Patricia Starck might be considered.10•11 She recommends we follow Frankl's lead as proposed by his The Unheard Cry for Meaning, and replace the word logotherapy by the word logotheory for those classes and study groups that have no connotation of doing therapy but encourage thoughtful adults to consider the Implication of Frankl's thought for their own lives. Such classes might carry academic credit, but would normally be provided through extension programs for people whose main Interest Is not academic but Is personal. 


The Challenge 
Logotherapy Is centered on personal change. However, personal change always takes place within an historical, economic, social, and polltlcal context. 
Certainly the world has changed since Frankl developed his Ideas. Just as logotherapy made the transformation from Europe to the United States In the 1950's, It Is challenged again to make the transformation to the next century. Frederic Hudson wrote: 
We treat change as a problem, not an Issue. Unfortunately, change Is not only an Issue; it Is the dominant issue for our foreseeable future, and the empowerment of adults In our time depends on finding ways 
21
to be friends with change.15' P
100 
GRACE KANNADY, PH.D. [1613 Brittany, Olathe, Kansas 66061 U.S.A.] 
diplomata In logotherapy, Is Instructor of educational psychology at Kansas City Kansas Community College. She is also adjunct faculty In the Graduate Counseling Program at Webster University in Kansas City, Missouri. 
References 
1. Banks, J. & McGee-Banks, C. (1993). Multicultural education: Issues and perspectives. Boston: Allyn and Bacon. 
2. Coates, J., Jarratt, J., & Mahaffle, J. (1990). Future work: Seven critical forces reshaping work and the work force In North America. San Francisco: Jossey-Bass. 
3. 
Frankl, V. (1978). The unheard c,y for meaning. NY: Washington Square Press. 

4. 
Frankl, V. (1984). Man's search for meaning. NY: Washington Square Press. 


5. Hudson, F. (1991). The adult years: Mastering the art of seff-renewal. San Francisco: Jossey-Bass. 
6. 
Naisbitt, J., & Aburdene, P. (1990). Megatrends 2000: Ten new directions for the 1990's. NY: William Morrow. 

7. 
National CouncU on Family Relations. (1990). 2001: Preparing families for the future (N.C.F.R. Presidential Report). MN: Author. 

8. 
Schaefer, R. (1993). Racial and ethnic groups. NY: Harper Collins College Publishers. 

9. 
Smith, R. M. (1990). Learning to learn across the lifespan. San Francisco: Jossey-Bass. 

10. 
Starck, P. (1985). Logotherapy comes of age. The International Forum for Logotherapy, 8, 71-75. 

11. 
Starck, P. (1986). •Logotheory" as solution? The International Forum for Logotherapy, 9, 60. 

12. 
United Way Strategic Institute. (1990). Nine forces reshaping America. The Futurist, 24(4), 9-16. 

13. 
Woodruff-Pak, D. (1988). Psychology and aging. NJ: Prentice Hall. 


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The International Forum for Logotherapy, 1994, 17, 102-107. 
MEANING IN LIFE AND ADJUSTMENT AMONGST MIDLIFE PARENTS IN HONG KONG 
Daniel T. L. Shek 
(ABSTRACT) The responses of 90 midlife parents to the Chinese version of the Purpose-in-Life Test (PIL) were examined on two occasions along with other tools assessing: a) psychological well-being, b) parental attitude, c) parent-child relationship, and d) quality of marriage. The PIL was internally consistent and had high test-retest reliability for this midlife sample. Subjects who had lower PIL scores had higher levels of psychiatric morbidity, midlife crisis symptoms, and life dissatisfaction; and they perceived their health as relatively poorer. Higher levels of life meaning were associated with better perceived relationships with children, higher levels of marital adjustment and satisfaction, and more positive perceptions of the value of children. 
The Purpose-in-Life (PIL) test was constructed to quantify the existential concept of meaning and purpose in life, which is operationally defined as the ·ontological significance of life from the view of the experiencing individual".1 The Chinese version of the PIL was translated by Shek,4 and data have been accumulated on its reliability and factorial structure.8 However, existing data were limited to adolescent samples and there is a need to further understand the internal consistency and temporal stability of the test in adult samples, such as midlife people. 
A survey of the literature shows that the role of meaning in midlife development is unclear with respect to psychological well-being, parental attitude, parent-child relationship, and the quality of marriage. If meaning in life is fundamental to human existence, it would be intimately linked to midlife adjustment. In fact, midlife years have been regarded as a period during which a "second identity crisis" along with examination (and re-examination) of life goals and purpose occur. 2'3 Therefore, it is important to examine the role of 

102 
meaning In midlife development, particularly with respect to the link between meaning In life and midlife adjustment. 
This paper reports empirical evidence on the relationship between Intensity of meaning (as Indexed by the PIL) and adjustment In a sample of midlife Chinese parents. Specifically, the following research questions were addressed: a) What is the internal consistency and test-retest reliability of the PIL for midlife parents; b) What are the relationships between meaning and different Indicators of well-being (Including psychiatric morbidity, midlife crisis symptoms, life satisfaction, and perceived health status) In midlife parents; c) What Is the relationship between meaning and parental attitude (with particular attention to the perceived value of children); d) What Is the relationship between meaning and family relationship (with specific focus on parent-child relationship and the quality of the marital life)? 
Method 
Instruments The Intensity of life-meaning was measured by the Chinese version of the PIL. Other scales used in the present study were: 
1. 
The Chinese version of the 30-ltem General Health Questionnaire !G!:::fQ}_--measures current non-psychotic disturbances. 5 

2. 
Midlife Crisis Scale (MCRl)--cleveloped for this study to measure problems arising from several areas of a midlife person, Including relationship with children, satisfaction with work, satisfaction with occupational achievement, and attitude towards the future. 

3. 
Chinese Version of the Life Satisfaction Scale CSATISFY}-measures an Individual's global judgment of his or her quality of life.7 

4. 
Perceived Health Status Index (HEALTH)-2 Items were used to assess a person's subjective evaluation of his or her physical health status. 

5. 
Value of Children Scale NCHILD)--12 Items were constructed to examine the value attached to children and their positive and negative Impacts on parents and the family as a whole. 

6. 
Parent-Child Relational Quality Scale (PCR)-4 Items were constructed to measure the parent-child relationship. 

7. 
Chinese Version of the Dyadic Adjustment Scale (DAS)-assesses the concept of dyadic adjustment.9 


a. Chinese Version of the Kansas Marital Satisfaction Scale CKMS)assesses one's satisfaction with the spouse, marriage, and the marital relationship.10 
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The first four Instruments can be regarded as measures of well-being, the last two are tools assessing the quality of the marital relationship. Based on the conceived relationship between meaning in life and well-being,8.a It was predicted that PIL scores would be negatively correlated with GHQ and MCRI whereas PIL scores would be positively correlated with SATISFY and HEALTH scores. Concerning the relationships between meaning In life and family relationships, It Is argued that a loss of life meaning would have an Impact on one's relationship with other people. Therefore, It was expected that PIL scores would be positively correlated with VCHILD, DAS and KMS, but negatively associated with PCR. 
Sublects and Procedures 
The subjects (N=90) were midlife parents, age 30 to 60, recruited via convenient sampling method. Each participant was interviewed twice, with an interval of 14 days, by a trained interviewer. A structured Interview schedule containing the assessment tools was used, and each interview took roughly one hour to complete. 
Results 
Cronbach's alpha showed internal consistency for the Chinese version of the PIL (alpha =.83 for the test session; alpha =.88 for the re-test session). Except for Item 16, corrected Item-total correlations (see Table 1) were found acceptable. Concerning the test-retest reliability, the coefficient of stability was highly acceptable (r = .81, p < .0001 ). 
Table 1 
Item-total correlations for the Chinese version of the PIL 
Item  Test  Re-test  Item  Test  Re-test  
1  .48  .63  11  .31  .37  
2  .60  .64  12  .41  .45  
3  .50  .71  13  .17  .31  
4  .53  .61  14  .23  .37  
5  .51  .45  15  .34  .24  
6  .50  .61  16  .08  .14  
7  .34  .58  17  .52  .64  
8  .51  .49  18  .21  .50  
9  .59  .65  19  .62  .58  
10  .48  .59  20  .56  .56  

The correlations between meaning In life and the comparison instruments are presented in Table 2. All of the predicted relationships between PIL scores and the scores of the comparison instruments during midlife adjustment were supported. 
Table 2 Correlations between the Chinese version of the PIL and measures of well-being, parental attitude, parent-child relationship, and quality of the marital life 
Instrument Test Re-test 
MCRI -.58*** -.68*** GHQ -.37*** -.31** SATISFY .38*** .55** HEALTH .35** .30** VCHILD .25* .35** PCR -.35** -.42*** OAS .33** .35** KMS .30** .31** 
* p < .05 ** p < .01 *** p < .001 
Discussion 
Results show that the Chinese version of the PIL in this midlife sample Is reliable and the Items are relatively homogeneous (except Item 16). The reliability findings mirror closely the previously reported data on the Internal consistency of the Chinese version of the PIL in adolescent samples.8 Furthermore, the present data show that the PIL has high test-retest reliability, suggesting that PIL scores are stable across time. 
Concerning the link between purpose in life and well-being, It was found that higher sense of purpose was associated with lower levels of psychiatric symptoms and midlife crisis symptoms. Additionally, higher PIL scores were related to higher life satisfaction and more positive perception of physical health. Such findings are generally in line with previous findings in Chinese populations.8'8 
The link between purpose In life and midlife crisis symptoms suggests that meaning in life may play an important role in midlife adjustment. Although it is possible to regard the present findings as evidence that well-being affects 
105 
purpose in life, the data also support the proposal that purpose in life affects well-being, because this interpretation previously has received more empirical support.6 
With reference to the links between meaning and family relationship, the data show that purpose in life is intimately linked with parent-child relationship, marital adjustment, and marital satisfaction. One possible explanation of this finding is that a lack of purpose might adversely affect one's motivation to maintain an appropriate relationship with other people (including one's family members) or to fulfil one's role requirements. 
Since the design of our study Is correlational, alternative explanations cannot be ruled out, and prospective studies to clarify the related issues are indispensable. Nevertheless, the present data sho~ definite relationships amongst purpose in life, well-being, parental attitude, parent-child relationship, and quality of the marital life in midlife Chinese people. 
DANIEL T. L. SHEK is at the Department of Social Work, The Chinese University of Hong Kong, Hong Kong. This work was financially supported by the Research Grants Council of the University and Polytechnic Grants Committee (CUHK9/91). 
References 
1. Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl's concept of noogenic neurosis. Journal of Clinical Psychology, 20, 200-207. 
2. Hunter, S., & Sundel, M. (1989). Midlife myths: Issues, findings, and practice implications. Calif.: Sage Publication. 
3. 
Kalish, R. A. (1989). Midlife loss: Coping strategies. Calif.: Sage Publication. 

4. 
Shek, D. T. L. (1986). The Purpose in Life questionnaire in a Chinese context: Some psychometric and normative data. Chinese Journal of Psychology, 28, 51-60. 

5. 
Shek, D. T. L. (1989). Validity of the Chinese version of the General Health Questionnaire. Journal of Clinical Psychology, 45, 890-897. 

6. 
Shek, D. T. L. (1992). Meaning in life and psychological well-being: An empirical study using the Chinese version of the Purpose in Life Questionnaire. Journal of Genetic Psychology, 153, 185-200. 

7. 
Shek, D. T. L. (1992). "Actual-ideal" discrepancies in the representation of self and significant-others and psychological well-being in Chinese adolescents. International Journal of Psychology, 27, 229. 

8. 
Shek, D. T. L (1993). The Chinese Purpose-In-Life Test and psychological well-being in Chinese college students. International Forum for Logotherapy, 16, 35-42. 

9. 
Shek, D. T. L, Lam, M. C., Tsoi, K. W., & Lam, C. M. (1993). Marital assessment in a Chinese context: An evaluation of three instruments. 


106 

Hong Kong Journal of Social Work, 27, 80-81. 
10. Shek, D. T. L, Lam, M. C., Tsoi, K. W., & Lam, C. M. (1993). Psychometric properties of the Chinese version of the Kansas Marital Satisfaction Scale. Social Behavior and Personality, 241-250. 
Logotherapeutlc Aphorisms by Viktor Frankl (selected by Elisabeth Lukas) 
Even in a life which we apparently have wasted, we can reactively discover meaning. Fear brings about what Is feared. There are sick people who have become sick because a psychiatrist considered them sick. Values cannot be taught; they must be lived. The wor1d Is not a document we have to decipher but a record we have to dlcdate. In a genuine encounter I self-transcend, not self-actualize. Into an existential vacuum not only a neurosis may enter, but also a pseudotherapy. Where we cannot change a situation, we must change ourselves. To question meaning Is not an expression of spiritual sickness but of spiritual maturity. We are responsible for what we have made of our potentials. What matters Is never a technique as such, but the spirit In which the technique is used. Self-actualization Is the unintentional effect of life's intentionality. Human behavior Is not dictated by the conditions in which we find ourselves, but by decisions we make about them. Heredity offers the material which we can use to build our life. Every situation emits a call to which we have to listen. 
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The International Forum for Logotherapy, 17, 108-113. 
PARADOXICAL INTENTION: THE CASE OF RON 
James Yoder 
A 33-year-old client, Ron, appeared for treatment for his condition of anxiety. He feared certain people who he might meet and he had obsessive thoughts regarding failure. The condition was considered chronic because the client narrated Its origin In childhood. After his parents' divorce, his mother remarried (when he was about 10 years old). He experienced his step-father as harsh and psychologically abusive. Ron remembers compulsive actions or "undoing" behaviors which he attempted on his way horn from school "I would toss a rock on a certain crack in the sidewalk." The act wa to "undo" the anxiety and fear he felt In relation to his arrival at home--where h was frequently exposed to his parents' loud quarreling. Ron's mother and slst both had long-term phobic and obsessive-compulsive conditions. 
Ron Is happily married and Is the father of two small children. Though h attempts to hide much of his obsessive-compulsive behavior and fears from hi wife, he concedes that, "She knows anyway, but we don't mention it." 
Ron Is exceedingly successful as a manager of a sales firm. He mentions, do my job well. Under my direction the company has increased two-fold. Everyon expects success from me. They think I'm hard as nails." 
Ron views himself as a "good person, intelligent, kind, and always trying to d the right thing.· He concludes that he Is very successful In achieving his goals having a new house, having a family with children, and making more money tha ever. 
Ten years ago, Ron began smoking pot with some of his friends. His motlv was to attempt to manage his anxiety. However, he reports that the pot seem to make it worse. Consequently, he stopped this attempt to manage his fears. 
Recently, in attempting to manage his obsessive thoughts about failure, h began to drink. "I drink a couple of shots of vodka before I make a certai business call, etc." On the day he first visited my office, Ron, though he had ha his vodka, "fell to pieces.• He could not follow through with the business call. H 
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asked for an emergency appointment. He could not get rid of the obsessive conviction that he would fall to pieces and that his head would start shaking. 
Treatment 
In this case of obsessive-compulsive symptoms, Fabry's outline for use of paradoxical Intention In treatment was followed.1 This Involved arranging for the patient to have a medical examination. The examination was needed In order to rule out any somatic cause and to determine If medication was needed. In Ron's case, his medical doctor prescribed a mild dose of valium. Step 2 included selfdistancing techniques to calm him. 
I am not the obsessive thoughts. The real me shines strongly and brightly behind them. I can put the fear on the bench beside me. I can see It as a shy child, and ask It what It needs and wants. Also, I can ask It how It Is trying to help me. 
(These methods of self-distancing lead to attitude modulation in relation to the obsessive fear.) 
Stage 3 is the educational process that Informs the patient what paradoxical Intention is and how It works. Case histories of successfully treated patients are shared. Also, at this stage it Is Important to check the level of the patient's sense of humor. Since paradoxical Intention as treatment method Is contingent upon a sense of humor, I asked Ron to •Go ahead and show me how your head shakes. ¦ He, of course, laughed and said that he could not. It is also Important, as Fabry points out, that the clients understand that within themselves is the power and strength to succeed. 
The 4th stage Includes gearing the paradoxical Intention formulations to the specific client situations: e.g., •1 want to fall down on the floor at my next appointment. Everyone should see how wildly I can convulse and shake my head.• (Remember, the formulation should consist of the event or consequence that the client fears may happen. In this case, Ron was expecting nervousness, palpitations of the heart, and a trembling head.) The paradoxical formulations need to be specific. 
The 5th stage includes the practice of the formulations. •Heck, who wants to be perfect? I'll make 200 mistakes today.• Or, •1 really want my head to shake so badly that it will fall off and roll out Into the hall.• Fabry cautions, •eare must be taken so that patients do not feel they are being ridiculed, rather they are being helped to ridicule their own symptoms. •1• p.28 
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The 6th and final step of applying paradoxical Intention Is often the most difficult. That is the point when the person must actually apply the formulation to the feared situation. 
"The therapist will assume responsibility that nothing will happen to the patient, but the patient must take the responsibility to go out and try." 1• p.28 This must be done, even if it Is only to prove to the therapist it won't work. 
A tape of the 6th counseling session revealed the patient's progress. 
Ron began the session by telling me that at that very hour he was free from the fear of falling to pieces and having the shakes. •it (the fear and dread) was off flying over Texas somewhere." However, during the past week he had had a minor set-back. He had a business appointment that he very much desired to keep. One part of him said, •1 know I can do It. Yet the obsessive thoughts rose up into a mounting fear. So I took a vallum, then left for the appointment." On the way he attempted to apply the paradoxical formulations, but the fear increased. He went to a phone and attempted to call me, but couldn't get through. Obviously, the anxiety and fear had mounted to such an extent that paradoxical Intention was not a viable intervention. He realized this and took another 5 mg. of valium. He was able to keep the appointment. •somehow the fear vanished. I'm the conqueror.• He attributed his success to more than the vallum--perhaps the part of him that had said •1 knew all along I could do It.• The meeting had concluded with him achieving considerable business success. 
Even though medication was used, this was a successful venture for this client. Only two weeks prior he had not been able to carry through with a business appointment, even after "two vodkas.• This step evidenced definite noetic strength. 
The client then turned to his childhood and narrated some things about the pain of his past: 
Client: When outside at the baby sitter's I would toss a rock at a crack. It would mean my mom would say that I could come home. I used to kick rocks on my way home from the grocery store. I'd go out of my way to kick stones Into the street as if a car, in going over It, would have a flat tire. It was my Intent In so doing that everything would then be all right. It was like a dark thing moving over my head. I had to do whatever I could. I guess I chose the compulsive behavior. I had to prove myself worthy of not suffering wrath (troubles at home). I didn't have a happy childhood. There were many bad things. 
Counselor: You suffered much in the past. It tended to cause you to expect the worst. Client: Even before that, my mom and dad always fought. My dad was an alcoholic. My sister was just terrified of him. It always came to a head on Friday 
110 
night. (Here the tape fades out. Later in the session, he discusses how he plays tennis and jogs, and how this exercise helps the anxiety go away.) 
Counselor: Even though you often learned to expect the worst, the history of your life shows that you have been successful--home, children, money, your job. You have many achievements. It becomes a matter of trust--"Can I trust that life responds when I give my best efforts?" 
Client: Yeah. I can see that. I have always expected the worst to happen. For a long time, the worst did happen. Counselor: You had good reasons for developing this attitude. It was an attempt to protect yourself. 
Client: (Here the client begins to tell about successfully handling a difficult situation with an employee who had been irresponsible. He had become anxious about this confrontation. He feared that he would become too angry.) "I feared I'd begin acting inappropriately, the head shaking and all of that--but It went o.k." 
Counselor: You were able to use your formulations: "Go ahead, fall to pieces-let my head shake off and roll under the desk!" 
Client: Yes, I really tried to whip It up, at least at the beginning. I began to feel like I was really in control. I'd say I handled It really well. You know, I had to inform him of how he hadn't been responsible. Surprisingly, It went very well. 
Counselor: A little stress--but you chose to do It. You were being responsible. You were successful. You found that you had the strength to do it. As you said earlier, you always knew you had that strong part of you. 
Client: Yes. I guess my greatest fear was that someone would see me get intimidated by this guy and then I'd behave badly--what they'd think of my--you know. 
Counselor: Someone might see your incompetence. 
Client: My weakness. But, it turned out all right. From this point on the client discusses his need to set realistic goals. He needed to have little successes along the way that would lead to greater realization of his potentials and strengths. Particularly, he desired to get to the point where he no longer needed to rely on the medication. 
A week later his condition had improved. However, as with many very anxious clients who experience anticipatory anxiety, there is a part of Ron that is still doubtful and Insecure. It is the therapist's responsibility to face this insecurity--to get It out on the table, so to speak. The worst times during the client's week must be examined. Then there must be an emphasis upon successful application of paradoxical intention when the obsessions and anxiety mounted. 
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At the next session Ron's self-doubt emerges. It Is my duty to hear him, but also to mirror back to him the brightness of his achievements that shine through his self-doubt and anxiousness. 
Client: Sometimes I feel as If I'm not making any progress. 
Counselor: The facts are otherwise. The anxiety Is not present. As you indicated, Its •tocked In the trunk of the car. ¦ You very courageously have tried to join and make friends with the fear and anxiety, Instead of fighting It. You demonstrated your success In handling the situations where you had to confront a member of your staff. You successfully applied the paradoxical Intention. 
Cllent: I just feel llke I should be doing more. One thing that brings me a lot of comfort Is that at least I'm doing something about It. 
Counselor: Tell me the worst times since we last met. 
Olent: Occasionally I have fleeting encounters with It-like when I'm with a group of people. As I said, I call It the •crung. • Counselor: Tell me about the •crung• this morning. Oient: Well, I was In the dispatch room with four or five people. I got Involved 
In telllng them something. Suddenly I became very conscious that It would take me several minutes to finish talking and all the attention was focused on me. I had fleeting thoughts that maybe my head would start shaking. But-uh-I got through it really well. I said to myself •Go ahead, head, roll ott.• It just didn't come about. I got through It well. 
Counselor: You had a fleeting moment of anticipatory anxiety. When you tried to Increase It, It vanished. Your head did not shake off and roll under the coffee machine. You were successful. 
Oient: Another time I was playing racquet ball, and I was going to tell this joke. I forced myself. That Is, I put myself Into a situation where I had to finish the joke. If you don't then you appear weird. 
It's not like a conversation where you exchange comments and any moment you can excuse yourself. It's sort of a claustrophobic kind of thing. Anyway I was going to tell this joke. When I'm playing racquet ball, It seems I get all pumped up. My senses are more aware. I'm more susceptible to the fear. So I said, •rm just going to go ahead and do it anyway.• And I did. There was nothing. I got through it. I even turned my beeper off. You can tum it off and tum it back on to check the battery--it beeps. I can turn it on secretly, letting on that I have an emergency call if I need to--it's a safety escape. Right in the middle of the joke I turned it on and It didn't beep. It didn't work Oaughs). So I had to finish the joke, and I did. 
Counselor: What would be your paradoxical formulations next time you are In a similar situation and want to speak, or tell a joke? One of them might be "Oh, who wants to tell a good joke anyway--who wants a joke to be funny? Wouldn't 
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it be better if I forgot the joke In the middle anyhow? Who wants to be funny anyway?" The other might be "It would be even a bigger joke, more fun for me to collapse with the shakes. I'd really like that to happen.• 
aient: When do you use those? 
Counselor: The time to use the formulations is before the fear and anxiety mounts, before you enter the room and just before you tell the joke. (I share the experience of a previous client who experienced panic attacks just before each date. She used her paradoxical formulations as she began showering and dressing for the date, considerably ahead of having dinner with her new date. She would say to herself, "It would be wonderful to spill my drink over my bosom and even fall out of my chair. He would always remember me and the crowd would applaud.") 
Oient: When I went to the one meeting I was so worried about, I didn't say, "I want It to happen.• But I was kind of saying, ·1 don't care if it happens.• 
Counselor: The same thing. "Who cares? Who wants to be calm? It's so dull and boring. If I fall to pieces everybody will remember me.• (I review for him that he Is not responsible for his basic temperament-those parts of his soma and psyche that are determined through heredity. His responsibility is only for the attitude he takes toward the obsessive-compulsive personality tendencies. In addition, I point out to him that people with his personality make-up are the 200 percenters who achieve and succeed.) 
After 8 sessions the client had successfully mastered the panic attacks and was able to control many of the obsessive thoughts by "intending them.• His therapy discontinued. A month later he called and told of how he was able to ride In a van with six others, Including his wife, on a 150 mile journey without any attack. This, he told me, was something he had previously been unable to do. 
JAMES YODER, PH.D. [216 Klngsway, Hesston, Kansas 67062, U.S.A.] /s a 
dip/ornate in logotherapy and an author and lecturer. The above article Is excerpted from his book Meaning In Therapy: A Logotherapy Casebook for Counselors -used with permission. 
References 
1. Fabry, J. (1982). Some practical hints about paradoxical Intention. The International Forum for Logotherapy, 5, 25-30. 
113 

The International Forum for Logotherapy, 17, 114-120. 
FRANKL'S CASE OF ELFRIEDE G. 
Robert C. Leslie 
It was my unique privilege to be a student in Dr. Frankl's classroom when the patient described in this case was presented in a clinical lecture at the Polyclinic hospital amphitheater in Vienna on November 20, 1960. I was also present in Frankl's office when this same patient came in for a follow-up visit about three months later. When I left Vienna after studying logotherapy for eight months with Frankl, he presented me with a cartoon drawn by him, recalling this treatment. Let us turn now to the printed case, as it is found in The Doctor and the Soul 2• p.220-229 This is one of the most detailed of Frankl's printed cases. 
Using Data 
Under the heading "Using Data," this case reads: 
Mrs. Elfriede G., a thirty-five-year-old woman, was a patient in the Neurological Department of the Polyclinic Hospital when I presented her at one of my clinical lectures. Let me describe the setting. The clinical lecture, given in German, was held in 
the typical medical amphitheater with Frankl seated at a table on the floor level, surrounded by a semi-circle of seats in rising tiers, with about 40 students, largely from the Medical School. Before a patient was brought in, Frankl would leaf through a medical history prepared by an assistant and would share relevant details with the class. His report on this occasion is summarized as we turn back to the case. 
She reported that as a child she was meticulous, and while her friends were playing in the park, she stayed at home scrubbing and cleaning. For three years the patient had been virtually incapacitated by an extreme fear of bacteria; hundreds of times a day she had washed her hands. Fearing contact with germs, she no longer left the house; fearing exposure through outsiders, she excluded all visitors. She would not even allow her 
114 
husband to touch the children for fear he would transmit germs to them. Finally she wanted a divorce because she felt she had made her family unhappy. She had been institutionalized because of several attempts at suicide. After unsuccessful treatment in various clinics and hospitals, she had finally been taken to the Neurological Department of the Polyclinic Hospital by ambulance, for she had become completely helpless. Logotherapy takes a very individualized approach, basing treatment upon the 
specific circumstances of a person's life. In an age in which persons tend to become numbers to be punched into a computer, logotherapy pays attention to whatever it is that makes a person unique. The personal life experiences are important. 
I recall another occasion In the same amphitheater when a brash young American student addressed a facetious question to Professor Frankl. "Dr. Frankl,· he asked, "what is the meaning In my life?" In his usual attentive way, Frankl took the question seriously, and drawing upon his knowledge about the student, he replied: "The meaning in your life may be for you to return to your pre-med course at the University of Minnesota to introduce your classmates to theory and practice of logotherapy." This was Frankl's way of reminding the student, and everyone in the class, that the meaning in anyone's life is a unique matter, taking Into account the particular life experiences that are a part of one's personal history. 
Frankl writes about how new meaning can be discovered when undeserved suffering can be interpreted as having the possibility of contributing to meaning. Indeed, the personal data which may be the most important may be related to suffering. Frankl comments on how a prisoner, described by a social worker as "probably the most hopeless Individual I have ever seen,• had never been taught "that even suffering Is of potential value."1' p.s Indeed, to emphasize this point, we might add parenthetical words to my first heading so that it reads: "Using data (including suffering)." In an age In which the common tendency is to run from any kind of suffering, Frankl affirms its positive value: 
Suffering and trouble belong to life as much as fate and death. None of these can be subtracted from life without destroying its meaning. To subtract trouble, death, fate, and suffering from life would mean stripping life of its form and shape. Only under the hammer blows of fate, in the white heat of suffering does life gain 
shape and form.2• p.,,, 
When Elfriede G. was brought Into the amphitheater, she had the typical appearance of a deeply depressed person. Every aspect of her body conveyed despondence. She barely moved her legs as she shuffled across the floor. There was no animation on her face, only a blank, worried expression. Her hair was 
115 
uncombed, the whole manner was one of careless indifference. When she reached 
the chair beside Frankl's table she slumped Into it with an air of resignation. She 
presented the classic picture of depression. 
Arousing Hope 
Frankl's notes continue under the heading •Arousing Hope.· 
In the lecture hall of the hospital, in the presence of a class of students, I spoke to the patient for the first time. I asked her: • Are you accustomed to check the door many times before leaving home, or to check whether a letter has really fallen Into the mailbox or not, or to check several times whether the gas valve Is really closed before going to bed?· "Yes, that Is my case: she said anxiously. I then proceeded by pointing out that this meant she belonged to a certain type of character structure which In traditional European psychiatry was conceived of as ·anankastlc, • and that this meant Immunity to psychoses. A sigh of relief was her response, relief after long years of suffering from the fear of becoming psychotic. Because of her fear that the obsessions had been psychotic symptoms, the patient had fought them. By this very counterpressure, 
however, she had Increased the pressure within herself. I then remarked: "You have no reason for such a fear. Any normal person can become psychotic, with the single exception of people who are anankastic character types. I cannot help but tell you this and destroy all your illusions In this respect. Therefore you need not fight your obsessive ideas. You may as well joke with them.• 
Frankl's optimism is contagious. He believes that people can do something about their predicaments, and he conveys that conviction. I have heard him say, •1 can help anyone who comes through that door.· He goes on to say that the help he can give may not be the help expected! The help he offers has more to do with a change of attitude than a change of circumstances. 
I believe that a major part of the effectiveness of logotherapy lies in the hope it arouses. In a nuclear age when the whole world can be blown to extinction by a nuclear disaster, it is hard to be optimistic. But Frankl, who lived through two . and one-half years in four different concentration camps, as hopeless a situation as anyone could imagine, persists in hoping. He places hope, however, not in technical advances in sky wars but in the resiliency of the human spirit. 
In doing crisis Intervention the therapeutic strategy has been to be the arousal of hope. In a crisis situation, when circumstances seem so impossible, hope diminishes and coping capacities seem non-existent. But when a counselor offers 
116 
to stand by, affirming a promise of hanging in there with the counselee, and thus arouses hope that was largely lost, a change can take place. 
Changing Perspective 
In "Changing Perspective," Frankl demonstrates one of his specialized techniques which he calls "paradoxical intention." To break up a non-productive and usually destructive pattern he paradoxically encourages patients to do the very thing which they feared, and thus demonstrates that they have more control over their behavior than they had believed. The main point is not so much the particular technique as it is a change In point of view. How this change is brought about is less important than the fact that it happens. 
Frankl writes about the case of Elfriede G.: 
Then I started paradoxical intention. I invited the patient to imitate 
what I did. I scrubbed the floor of the lecture hall with my hands and said: 
"After all, for the sake of a change now, instead of fearing infection, let's 
invite it." Stooping and rubbing my hands on the floor, I continued: "See, 
I cannot get dirty enough; I can't find enough bacteria!" Under my 
encouragement, the patient followed my example. I remember that scene in the Polyclinic amphitheater very dearly, partly because of the cartoon Frankl drew for me about it. The cartoon shows Frankl, in his doctor's coat with his neurologist's hammer in his pocket, bending down to rub his hands on the floor, and Elfriede G., in her shapeless hospital garb, kneeling on the floor with him and rubbing her hands on the floor. The caption Frankl wrote above the cartoon is: 
In Frankl's Classroom: 
Bob: "If that's why I came over here--to watch a psychiatrist scrub the 
floor...What a sabbatical!" 
What I remember most about the occasion is the comment Frankl made after he had rubbed his hands vigorously on the floor, and then had rubbed his hands on his face, asking the patient to follow his example. She had hesitantly gotten up from her chair, gotten down slowly on her knees beside him, and begun to rub her hands on the floor. He encouraged her to "rub harder'' and then to rub the germs off her hands and onto her face. As she did so a strange expression came over her face. Frankl noticed it, and turning to us in the amphitheater seats, said: "Do you see, she's smiling. She's getting well already." And of course it was true. Through her fingers on her face we could see that her face, which up to that moment had shown only indifference or despair, was now breaking out in a smile. 
The most dramatic moment came when the patient left. Frankl had invited her to be seated again and had talked with her at some length, not about her anxieties 
117 
about germs but about her love for her family and especially for her children. As she talked with him, her manner was radically changed. There was animation In her voice and on her face. She spoke clear1y and confidently. It was obvious to all that she was a changed person. When she got up to go out, her actions were completely different. She marched confidently from the amphitheater with her head held high, a transformed person! Her whole perspective had been changed. Returning to the clinical notes, we read: 
And so she began the treatment which, in five days, removed ninety per cent of her symptoms. Regular therapeutic treatments with my associate speeded the recovery. Thus an Incapacitating pattern of three years' standing was broken up In a matter of a few weeks. She spoke jokingly of all her former symptoms. She asked her fellow patients whether any of them could provide her with •some more bacteria.· She cleaned post-operative patients in the Laryngological Department. She was In steady contact with bloody things. She washed her hands only three times a day although she frequently handled putrid material. She wanted ¦io make as much acquaintance with germs as possible.• She spontaneously declared: •t want to let the poor beings live and not wash them away.• 

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Centering on Meaning 
The fourth topical heading Is "Centering on Meaning.· The notes continue: 
On the sixth day she left the hospital to buy wool to knit a pullover for 
her youngest chlld, to knit it "here in an environment full of bacteria.· "On 
each loop of the sweater,• she said humorously, she wanted "one 
bacterium sitting." She was beaming with joy and felt completely healthy. 
When she went home for Christmas her behavior was, for the first time, 
as normal as it had been before the onset of her neurosis three years 
before. There was no longer any need to apply paradoxical Intention. The 
patient embraced the children, caressed them without the slightest fear of 
Infecting them. She resolved deliberately: "Now I will transfer the bacteria 
onto my children.• The washing compulsion had disappeared. "I am the 
happiest person on earth,• she declared. She was able to do everything 
In the normal routine Including tasks that formerfy she had not been able 
to finish. She did all of the housework and devoted herself to her children 
as she had not been able to do since her neurosis became full-fledged. 
She was able to devote herself to her youngest child for the first time In 
his life! 
Because Frankl used this case to demonstrate paradoxical Intention, It Is possible to read the case to miss an essential aspect of it. When the patient had returned to her seat, Frankl talked with her about her children. He thus deflected her attention away from her obsession about germs and focused It on an Issue of great importance to her--her children. In so doing he came to the heart of his treatment, a centering on the personal meaning for her life. 
I recall asking Frankl how he understood the dramatic transformation that we had witnessed taking place before our eyes. He replied by describing the two-fold approach which he had used. He said: "I mobilized the defiant power of the human spirit to stand over against the problem, and I focussed attention away from her predicament and onto the meaning in her life.• 
Where the case notes read that the patient had said: "I will transfer the bacteria onto my children,• they might well have read: "I wUI transfer attention from the bacteria to my children." 
One further detail from the more complete notes Is of Interest. The notes as printed Indicate that the onset of the neurosis (the hand-washing obsession) had been "three years before.• The more complete notes Indicate that it was "three weeks before" that the youngest child was born. Frankl comments In his notes: 
So we have three converging Influences: 1) the biological past or heredity; 
2) the biological present or the pregnancy involving endocrine changes; and 3) the psychological situation, Involving conflict and other dynamics. 
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You will notice that I was not concerned with all this when starting therapy. I did not delve into the background of complexes and conflicts. I did not ask about her marital life. My approach was not governed by principle so much as by didactic response. I would add that his approach was based on his conviction that the biological 
and psychological factors are Indeed Important and useful data, but recovery Into health calls for the Introduction of still another factor, a centering on meaning. 
Challenging for Responslbllity 
On the fifth topic, "Challenging for ResponsibDity, • the clinical notes say: 
Some time later I asked her about the washing compulsion. She replied: "I have to laugh at that now. It seems quite unreal to me that I ever had to suffer from anything like that. Now at ten o'dock In the morning my housework is finished. Before, I got up at three o'dock in the morning and even by night my housework was not completed." I was present In Frankl's office when Elfriede returned for a follow-up visit. It 
was March 8, 1961, about 3 months after she had been discharged from the hospital. Her appearance was remarkably different from my initial observation of her In the amphitheater. She was neatly groomed, was radiantly happy. It was clear that she regarded herself in the manner in which Frankl had challenged her as she left the hospital. He had said: "Regard yourself as cured." 
ROBERT C. LESLIE [646 Santa Rosa Avenue, Berkeley, California 94707 U.S.A.) 
is professor ofpastoral counseling, emeritus, Pacific School ofReligion, Berkeley, California, and curator of the Viktor Frankl Library and Memorabilia, at the Graduate Theological Union, Berkeley. 
References 
1. 
Frankl, V. (1955). Don't give me up. In S. W. Standal & R. Corsini (Eds.), Critical incidents in psychotherapy. Englewood Cliffs, N.J.: Prentiss-Hall. 

2. 
Frankl, V. (1973). The doctor and the soul. NY: Vintage Books. 



120 
. ISSN 0190'"3379 IFODL 17(2)65-128(1994) 
The zntern~tional Pora for 
.·LOGOTIIBRAPY 
Journal O~. ~•arcb···· for· Beaning 
When An Offspring Dlesi~yfn Bete'avemen\
G . ·,.. , . . . 65 
roups Gustavo Berti and Alica, SchnaJder lkml Aphorisms by Elisabeth 1.u1-• . 69 The Meaning or-Chrome ~ffie.riote rl0. ' ··. ,,, Human Spirit in Conftfct ResdU,UOn · · · 70 Ingeborg van Pelt .... Logotherapy: AJ~Y.ltlt~. Meanfnct'.•r:or·l'eopie: .. 
with ,JD!ma GioAnco mlf Jatk1-~ · 
76 
Logotherapyln Schoel.~ Situation. ... 82 ..., Bfalnca'Z Hirsch.. .;. . 
Uses<Of Hypnosll kt~ 87 · R. R.. Hutzell and Jim Lantz Self-Transcendel1ceJnJhe ~•· . 93 MO$he-Adc:lad · . Rethlnking·~·tralni~:~ 96 
.. Grace Kannady .. · Meaning In·ue And Ad}USt~·ArnonQ$J• ~tdllfe · Patients ln.Hong·•Kont . . 102 .Daniel T. L Shek Aphorisms.by Viktor,F....,ld 107 Paradaxlcaf Intention: The Gase Of Ron 108James· Yoder . . . Frankl's Case of Elfriede G. 114 Robert C. Leslie Book Review 121 Recent _Publlcatk;>ns of lnter8$t to ~pists·. 
123 World Congress Of Logotherapy: JnformatiOn/Call For Papers · 
126