Legal Responsibility of Logotherapists  65  
Robin W. Goodenough  
Logotherapy in Divorce Counseling: The Myth:  
of Mr. Wonderful  73  
Pamella Monaghan  
An Experimental Investigation of the Relationship  
Between Anger and Altruism  80  
A. A. Sappington, S. Goodwin, & A. Palmatier  
Comparison of Logotherapy and Brief Therapy  85  
Bianca Z. Hirsch  
The Pursuit of Democracy in Nigeria  91  
Rachel 8. Asagba  
Logotherapeutic Principles in the Treatment Of  
Panic Attacks With Agoraphobia: A Case History  95  
Richard I. Hooper, Mary K. Walling, & W. D. Joslyn  
Logotherapy Training: The Worthington Model  100  
Jim Lantz  
Serving the Summons to a Troubled World  104  
Paul R. Welter  
Coping with Life-Threatening Illnesses Using A  
Logotherapeutic Approach--Stage II: Clinical Mental  
Health Counseling  113  
Jared Kass  
The Nature of Counseling Relationships from the  
Perspective of Logotherapy  119  
Maria Ungar  
Recent Publications of Interest to Logotherapists  122  

Volume 19, Number 2 Autumn 1996 
The International Forum for Logotherapy, 1997, 20, 1-3. 
* * * BOOK REVIEW * * * 
Viktor Frankl: Recollections--An Autobiography 
Translated by Joseph B. Fabry and Judith Fabry. Insight Books, 233 Spring St., New York, New York, 10013. 1997. $24.99. 
Ever since first reading Frankl, I have wanted to see a reasonably chronological account of his life up to the time of the publication of Man's Search for Meaning in 1963. Scattered throughout Frankl's 31 books in German are occasional references to specific persons and particular events, but the chronological "Recollections" in this autobiography is very welcome and makes an excellent addition to Frankl' s work. 
Among the many details in this book are references to the members of Frankl's family, with many pictures of them. He writes that he probably inherited his focus on rationality from his father and on the expression of feeling from his mother (p. 22). He talks of his father's adherence to the dietary laws of orthodox Jews. He is proud of the fact that he stayed with his family in Vienna when Hitler took over and that he stayed with his parents when they were taken to a concentration camp at Theresienstadt (p. 20). Because he stayed with his parents he was able to inject his father with morphine to ease his suffering with pulmonary edema (p. 26). 
Frankl' s deep faith is a heritage from his father. The father often said, "Be of good cheer, for God is near," and "To God's will I hold still." (p. 26). 
Many of Frankl's ideas were formulated early in his life. He remembers, when he was four, talking with his mother about dying. He suddenly realized one day that he would have to die. "What troubled me then--as it has done throughout my life--was not the fear of dying but the question of whether the transitory nature of life might destroy its meaning." (p. 29). In struggling with these ideas, he came to the realization that "in some respect it is death itself that makes life meaningful." He goes on to say, "the transitoriness of life cannot destroy its meaning because nothing from the past is irretrievably lost. Everything is irrevocably stored." (p. 29). 
1 
Frankl tells that as a boy a friend of his parents spoke of him as "The Thinker" (p. 32). He notes that "in my view I was never a big thinker. One thing I may have been through my life: a thorough and persistent 'thinker-through"' (p. 32). He tells of taking some minutes to think "about the meaning of life, particularly about the meaning of the coming day and its specific meaning for me." (p. 32). 
Frankl spent a total of three years in four camps. His father died in Theresienstadt "practically in my arms" (p. 100). His mother died in the gas chambers of Auschwitz (p. 100). Tilly, his first wife, was with him in Theresienstadt. She had joined his transport which was headed for Auschwitz by volunteering to do so. When the men and women were separated on their arrival in Auschwitz, Frankl said to her, "Tilly, stay alive at any price, do you hear? At any price." He was telling her that if she found herself "where she could save her life only at the price of yielding sexually, she should not feel inhibited out of any consideration for me" (p. 90). He learned eventually that Tilly had died with many others after the liberation of Bergen-Belsen by English soldiers. 
In addition to Theresienstaclt and Auschwitz, Frankl was imprisoned at Kaufering Ill and Turkheim, two outpost camps of Dachau. Only his sister had escaped the camps as she had gone to Australia. 
Some of the most delightful sections of the book are of Frankl' s testimonies to the help that his second wife, Elly, has given to him and to his work. His friend, Jacob Needleman once said of Elly, "She is the warmth that accompanies the !ight." (p. 12). 
Frankl has made 92 lecture tours to the USA, has gone around the world four times. When asked on one occasion in a group of American professors, psychiatrists, and students what the meaning of life has been for him, he asked the group how they would answer that question. "A student from Berkeley said, 'The meaning of your life is to help others to find the meaning in theirs.'" The answer had the very words that Frankl had used in filling out a questionnaire that had contained this same question (p. 129). 
Frankl provides a glimpse of how he works. He attacks disagreeable jobs first and seldom procrastinates when he takes care of chores he despises. 
Although Frankl often is scathing in his public denunciation of Sigmund Freud, he also had good words to say about Freud's contribution to psychology. What he objects to is the dehumanization of psychology, a matter he corrects in stressing the spiritual dimension in life. 
2 
Frankl had a deep affection for Alfred Adler, the second Viennese psychoanalyst after Freud. Frankl was a part of the Adlerian Society in Vienna until he was forced by Adler to resign. When the Adlerian Association was meeting on one occasion, Frankl sat next to Adler and listened while some of his fellow students spoke very critically about Adler. Adler turned to Frankl and some of Frankl's friends and said, "Well, you heroes?" Frankl says that what Adler wanted to say was that "we should have the courage to show our true colors by speaking up" 
(p. 63). Frankl writes: "I made the mistake of declaring myself right in front of the enemy." (p. 63). Adler never forgave Frankl and threw him out of the group. I heard Frankl tell about this meeting in the Polyklinik in Vienna. He said that when Adler challenged him, he stood up at the blackboard and wrote down three words: 
Body 
Mind 
Spirit 
He told Adler that the Adlerian way took into account the body and the mind but overlooked the spirit. 
In this book, Frankl writes in italics: "A theme runs like a radiant thread through all my work, and it concerns the border area that lies between psychotherapy and philosophy with special attention to the problems of meanings and values in psychology." (p. 59). Adler was deficient, Frankl believed, in leaving out meanings and values. 
Springtime. We visited Auschwitz. As we were leaving, Frankl had us stop beside a flowering tree to take a photo. Some smoke was coming from an industrial chimney. He noted that, where once there had been smoke coming out of the furnaces of the gas chambers, now there was smoke telling of a renewed economy in Auschwitz. This was a picture that he wanted to carry away from Auschwitz, a picture of hope. Frankl's hope for the future permeates this book. 
Reviewed by Robert Leslie, Emeritus Professor of Pastoral Psychology and Counseling, Pacific School of Religion, Berkeley, California 94709 USA. 
3 

The International Forum for Logo therapy, 199 7, 20, 4-10. 
EXPERIENCE WITH LOGOTHERAPY AND EXISTENTIAL ANALYSIS IN A HOSPITAL FOR PSYCHIATRY, PSYCHOTHERAPY, AND NEUROLOGY 
Karl-Dieter Heines 
If Viktor Frankl had not established logotherapy, a psychotherapy that includes the human spirit would have been born soon because it was needed in our time of spiritual needs. That it was Frankl who founded this meaningcentered psychotherapy was an especially happy coincidence. His example and his teachings are an unignorable, loving, yet stern call to be a full human being in our times. 
Since the fifties, I have personally experienced how Frankl and his teachings received high recognition as well as strong rejection. My academic teachers praised his clear, pragmatic language, the high philosophical level, and the warm relationship between physician and patient inherent in his teachings. I found strong rejection in analytical, depth-oriented circles when I spoke of the forces of the human spirit, of conscience, and the awareness of responsibleness, meanings, values, and dignity. With a patronizing smile or arrogance I was asked if I did not know that all this was part of the superego or of the psychoanalytical ego-psychology. 
In 1962 I was exposed to strong rejection by psychoanalysts. I told Frankl that I wanted to talk to some of the prominent Viennese psychoanalysts. Frankl said, "If they hear you talked to me, they won't tell you anything." He was right. I met icy rejection when I told them about my talk with Frankl. Since then, such unjustified rejection has given way to world-wide acceptance in all fields of the 
4 
humanities. Especially satisfying for Frankl must be the belated but clear recognition from persons in the fields of politics and economy in his native Austria. 
I have promoted logotherapeutic thought in my lectures to the patients in our clinic, in schools, and seminars for seniors. Each year, 500 patients, students, and seniors enthusiastically have listened to Frankl's life-affirming view of human nature and the world. 
Again and again patients have urged me to explain Frankl's logotherapy, through case histories, to new patients immediately after their admission to the clinic. The treatment, they have said, would be faster and more effective if the patients were able to find the way to a new, meaningful life. 
In my lectures to patients I am particularly concerned to open them to Frankl's basic ideas such as their attitude of courage to the tragic triad of unavoidable suffering, guilt, and death. Another of Frankl's ideas I treasure is his emphasis on the human longing for a link with Ultimate Meaning as a highly personal decision. Frankl states that those who believe in the meaning of their lives throw the weight of their entire personality onto the scale to tip it in favor of meaning. They decide for themselves to lead their lives "as if" it had meaning under all circumstances. 
To believe in Ultimate Meaning is humanity's oldest, deepest, and most urgent longing. In my lectures on Ultimate Meaning I leave it up to the patients to remain open to this experience. In a quiet moment or out of life's fullness, they may someday experience Ultimate Meaning. One patient expressed it in these words: "Through Viktor Frankl and you I found faith--faith in meaning. Could you talk to my children so they might realize what faith in meaning could mean in their lives?" 
My lectures about Frankl's views on the meaning of love have motivated many patients to make a new beginning in a love relationship. One can hardly express it more succinctly than Frankl: "Love is, at the same time, a gift, magic, and a miracle." In a group, a cynical man said, "Love is nothing but a mixture a maudlin sentimentality and jealously." The women in the group objected violently. After the emotions had quieted down, one woman said softly, "For me, the word 'love' is still a bit holy." 
For me, the essential part of Frankl's work is the firm belief that even in cases of severe psychotic illness or organic brain damage, 
5 
the spiritual dimension of the patient remains healthy and accessible to healing advice. A second logotherapeutic belief is that we can reach the core of a patient's personality with a loving approach. 
Following these two beliefs I have approached thousands of patients and treated them intuitively and by improvisation. The successes have often amazed me. 
Some Examples 
The first example shows how a loving approach, experienced by a psychotic patient, created a trust that enabled him to report a severe identity crisis in the course of his psychotic illness. The young man, who had suffered a few days previously from confused thoughts, irrational visions, and imagined voices, wrote to me: "In my sickness I was no longer myself. I was my own double. Now I am the double of yesterday, myself again. You, Dr. Heines, understand me, although my thoughts occasionally still fly in all directions. So I tell you, 'Try to read between the lines of my thoughts.'" 
My second example shows how, in the course of a schizophrenic illness, essential elements of the spirit--the conscience, a sense of responsibility, and the possibility of realizing creative, experiential, and attitudinal values--still remain intact. The patient smashed a chair on the edge of a table in a moment of schizophrenic rage. I asked him why he didn't smash the chair into the television set to vent his anger. He tapped his forehead and said, "I am not crazy. Then we could no longer watch it." Surprised by so much insight I asked him if he could stop his violent outbursts which frightened the other patients. Embarrassed, he answered, "Yes, I could, but it would be difficult." 
Third example: Alcohol and drug addicts often have only a tired smile when, after the early stages of detoxification, we talk about the necessity to discover meaning in their lives. But there comes a moment, after the third or fourth month of withdrawal, when many patients declare: "You need no longer talk to me of the meaning of my life. I know my life has a meaning again. I again have trust in myself. I again experience joy with my wife, my children, my job." 
A journalist who had been extremely skeptical became fascinated, in the course of her detoxification, by Frankl's meaningoriented ideas and wrote an enthusiastic article with the headline: 
6 
Viktor Frankl' s Incredible Offer. A nihilistic public prosecutor told me, a few months after his withdrawal delirium, "If I had read Viktor Frankl instead of Jean Paul Sartre, I would not have become an alcoholic and landed in your clinic." 
Paradoxical Intention Examples 
Fourth example: A reputable Bremen merchant, in his mid-thirties, was admitted to our clinic because for five years he had suffered from an automobile phobia. He had witnessed a car accident on a highway and developed the obsessive fear that he also could become involved in such an accident. For five years he had not driven. Now he wanted to drive again because his five-year-old daughter complained that other fathers drove their daughters to outings, and she wanted her father to do the same. 
I immediately had good human contact with him and felt he was ready for paradoxical intention. He told about his fear that he might faint on the highway and lose control over the vehicle: he could veer to the right or left and smash the car. I convinced him that he was physically perfectly healthy and there was no reason to fear any fainting caused by illness. I explained to him that his phobia was based on his inclination to have precise control over his life and to avoid risks. I suggested that he visualize vividly all the situations he had feared all these years. We then practiced together imagining how we veered helplessly toward the right, then the left, smashing the car each time. We talked and practiced for 90 minutes. He was exhausted--but I had the impression that he had gained distance from his phobia. 
We agreed to repeat the exercise session in three days. On the day before our next meeting, he called saying he had driven, for the first time in five years, from his home to his office, and without the least fear. He was convinced he could master farther distances. We then agreed he should drive with his wife and daughter from Bremen to southern France for a vacation. He succeeded in driving this great distance, both ways, without any trouble. 
Fifth example: During an evening dance in our clinic, I asked a lively 49-year-old patient to dance with me. She declined, explaining that she was in the clinic because of shaking in both her hands, sometimes in her entire body. I realized that the shaking, which had affected her for the past half year, was psychogenic and that I could 
7 
help her with paradoxical intention. Smiling at her, I told her that I could help her if she were ready to dance with me. On the dance floor I told her, "Now we'll show the others how strongly we can shake together." During the dance I held her, as is usual, with my left hand by her right, and immediately began to shake strongly. Caught by surprise, she was right away ready to shake, too. After a while her shaking became much weaker, so I energetically asked her to continue her strong shaking. She smiled at me and said, "I don't understand, but I cannot shake any more with you." Finally I could only force her hand to shake using mine; she was unable to shake on her own, whether on purpose or not. 
Three weeks later she told a therapy group of 20 people, "Something strange happened to me. I came to this clinic because of a shaking in my hands. During the last dance evening Dr. Heines asked me to dance. He suggested we both shake on purpose, he with his left hand, and I with my right. All of a sudden my shaking disappeared. And I am convinced it will never come back." 
Sixth example: A 22-year-old cashier in a supermarket was afraid she would faint at work and lose her job. Six months before she came to our clinic, her boyfriend had left her. Since then she often felt dizzy and "weak in her knees." However, she was physically healthy and mentally alert. 
She heard me speak to our patients about my therapeutic approach to anticipatory anxiety and the fear of fainting. I said that people who tend to be fearful often suffer from fear of fainting which, however, is completely harmless. It was important to face such fears courageously. The fear would then lose its power and sometimes completely disappear. 
A week later I spoke again of the compulsive fears which can be very disturbing for many people. In the midst of my talk the young cashier called out, "I had a much better idea. I told my fear directly, 'I know, my dear fear, you have always been a part of me, and that's why I like you. Come one, I'll give you a good hug.' And when I hugged her, my fear shrank. The next day I tried to hug my fear again but couldn't because she was gone. Tomorrow I'm going home and back to my job. I wonder if the fear will come back there." One month later the patient reported the fear had not returned. 
Seventh example: One day I sat with Frankl in a circle of logotherapists in a Viennese pub. He was recounting his experiences 
8 
as a clinical psychiatrist. Suddenly he winked at me and said, "Dr. Heines, you will probably agree with me that, in his trust of the physician, the patient may interpret an unfortunate or even wrong word spoken by the physician to find recovery." I can fully confirm this. Here is an example: An alcoholic with severe liver damage came to my office, leaned on my desk, and asked me, "Doctor, can you understand that I wantto drink myself to death?" Somewhat thrown off balance I said defensively, "You can't scare me." The patient apparently interpreted these words as advice for a wholesome approach to his sickness. He surprised me by his favorable physical and mental development. He succeeded in finding a new job. Shortly before his release, he said to me, "Everything this clinic has done for me was well and good. But what really helped me was the advice you gave me. I told my sickness, 'You can't scare me!'" 
Love Changes Hate to Forgiveness 
With a concluding eighth example, I'd like to show how the basic logotherapeutic thought of loving trust can change hate into forgiveness. A 39-year-old, highly depressive secretary had long blocked the professional advancement of a man who had disappointed her in a love affair. In one of my talks to a group of patients I spoke of the healing force of love, the destructive effects of hate, and the possibilities of forgiveness. Even before I finished the sentence, the secretary called out loudly, "Then I, too, could forgive!" This spontaneous expression of a sudden insight moved us 
all.  Yes,  she succeeded.  She  was  able  to  forgive;  she strongly  
supported  the  career  of  her  former  lover;  and  her  "severe  
depression" vanished surprisingly quickly.  

Teaching Human Survival Values 
Frankl and I are very different, yet still close. He, the pioneering philosopher at the threshold of the new century; and I, working in the neuropsychiatric clinical world, trying to familiarize patients with Frankl's ideas in an effort to help them. We are close in our feeling the responsibility to help suffering human beings in their unique situations. 
Frankl plumbed the depth of human suffering in the concentration camps. In this personal "experiment" he experienced what humans are capable of, to triumph over their fate. Again and again, I have 
9 
asked myself, "How can someone, after years of German death camps, facing the prevailing nihilism of our times, still say yes to life? How can someone whose family was wiped out in these camps reject the collective guilt of the Germans?" With these two decisions Frankl shows us that the defiant "Yes" to life and the readiness to forgive are human survival values. 
In a play, written shortly after his liberation--Synchronization in Birkenwald--he indicated that human understanding and forgiveness far surpass malicious depravity and murderous crime. In a "metaphysical conference," Frankl has Socrates say, "I feel pity for the humans." The prisoner, Franz, hopes to be reunited in death with his loved ones. But Franz is destined to live to give testimony that will arouse people. Autobiographically, Frankl slips into the role of Franz. Frankl puts these words into Franz's mouth: "Eventually the chain of evil must be interrupted. We do not want to repay wrong deeds with wrong deeds forever." 
Viktor Frankl's call to humanness has spanned our planet, and it Is our task to make his message a reality. I am fascinated by Frankl's example and teachings. I have passed them on to many people who trust me and seek my help. 
It becomes increasingly difficult to penetrate the spiritual distress of our times. More and more people wander through life without help and goals. Frankl, with his teachings, has guided us through many confusions and illusions toward true humanness. 
Frankl's words will endure. But we will be judged by the way we have transformed his words into deeds. 
KARL-DIETER HEINES, M.D. [Deutsche Gesellschaft fur Logotherapie und Existenzanalyse e.V., 28325Bremen, Rockwinkelerlandstr.110, Germany] is the Founder and former Director of the Karl-Dieter Heines Clinic in Bremen, Germany. Dr. Heines is also the Founder and Past-President of the German Society for Logotherapy and Existential Analysis. 
10 
The International Forum for Logotherapy, 199 7, 20, 11-19. 
NURSE STRUCTURING OF A LOGOTHERAPEUTIC MILIEU FOR SCHIZOPHRENIC INPATIENTS 
Celia Wintz 
Nurses employed in psychiatric inpatient facilities face a challenge to their nursing practice which was unheard of in the past. They are asked to assist patients to reach goals in two or three weeks that once were accomplished in months or years. The following paper addresses resultant nurse issues in the treatment of schizophrenic patients. First, the role of the nurse in the therapeutic milieu is reviewed. Then 

clinically observed behaviors of schizophrenia are discussed. Goals for patients in the traditional hospital setting are compared with those expected in contemporary short-term hospitalization. Finally, a logotherapeutic approach is proposed as a framework for nurse application in the current therapeutic milieu. 
In the 1950s and 1960s the nation's psychiatric institutions admitted patients for lengths of stay that commonly ranged from three months to almost a year. Patients who were actively psychotic and/or experiencing what we now call the negative symptoms of schizophrenia often became semi-permanent residents. In the 1990s, the average length of stay in an inpatient facility is 17 to 21 days. This dramatic alteration in length of stay affects the ability of nurses to perform their previously identified functions. 
During the 1940s and 1950s, leaders in the field of psychiatry and psychiatric nursing formally delineated the role and functions of psychiatric nurses. Such conceptualizations were necessary because of two significant changes that occurred in the 1950s. Foremost was the introduction of antipsychotic medications in the psychiatric hospital. With the use of these medications, patient behaviors could be altered (especially the more florid symptoms of violent and aggressive 
11 
behaviors) making the patient more amenable to interpersonal and social interventions and more capable of participating in various ward activities. Secondly, the nurse's role was modified by the changing character of nursing education (from diploma based, on-the-job training programs to degree-granting universities) which produced a graduate nurse with knowledge that was more theoretically based and more focused on nursing as a profession with independent functions. 
Theory-based Nursing Function 
The pioneers of theory development shared a belief that the nurse was charged with providing a therapeutic milieu. Jones5 departed from the model of the psychiatric hospital of the 1940s (which focused almost exclusively on the dressing, bathing, and feeding of patients) and proposed instead the model of a therapeutic community. In this therapeutic community, special attention was paid to the communications that occurred between patients and the nursing staff, and to the formulation of the hospital's social structure (which was considered a nursing function). Taken together, the communication patterns between nurses and patients and the social structure of the hospital constituted the therapeutic milieu. Jones was respectful of the role the nurse played in the therapeutic milieu and recognized the nursing role as one with specific functions independent of the medical profession. 
Jones insisted that the nurse's role contained the following elements: (a) authoritarian, (b) social, and (c) therapeutic. The authoritarian role refers to the maintenance of the rules and regulations that are inherent in any group. Jones stated that the nurses "must align themselves with authority, and interfere actively in extreme cases--e.g., 
35 37
two patients fighting".5• P-· He contended that the nurse had an important role in crisis situations on the patient unit--being expected to assume responsibility for handling the confrontation and, when appropriate, processing the behavior with the patients. More surprising and innovative was his stated belief that minor infractions should be reported to the administrative staff who would then take appropriate action--this policy would relive the nurse of the discipline function in order to more easily perform in the social and therapeutic roles. 
The social aspects of the nurse's work required attempts to understand the patients. This was to be accomplished by tutorials (sessions in which psychiatrists discussed the psychopathology of the patients), talking with and being with patients during their daily 
12 
activities, and spending individual time with patients who needed the nurse's presence. 
Jones' description of the therapeutic role of the nurse was unique for its time. He did not believe that the nurse engaged in a psychotherapeutic relationship with the patient. However, he did conclude that the therapeutic role of the nurse involved two functions: 
(a) interpreting and transmitting the unit culture to the patient, and (b) answering patients' questions related to their personal issues. He asserted that the nurse should not interpret, but he acknowledged that the nurse could offer suggestions and in certain circumstances could play a more active treatment role, such as in group therapy and psychodrama. Finally, he asserted the nurse's importance in transference situations occurring outside of the formal psychoanalytic therapy. Thus he publicly recognized what patients and nurses had known for years--that a close and meaningful relationship existed between them. 
Peplau9 posited a nurse-patient interpersonal framework that delineated a variety of roles for the nurse, including: teacher, surrogate, and counselor. In the psychiatric setting, the nurse fulfills the teacher role by utilizing a problem-solving approach both in self activities as well as in assisting patients to employ the same technique in dealing with their own issues. 
Peplau described the transference process that occurs between patient and nurse: "Permitting the patient to re-experience older feelings in new situations of helplessness, but with professional acceptance and attention that provokes personality development, requires a relationship in which the nurse recognizes and responds in a variety of surrogate roles. "9• P-57 Psychological needs give birth to surrogate role formulation by the patient: "they give rise to psychological tasks to be met in nursing situations by nurses. • p.s, In current terminology this translates 
"9 to outcome criteria which the patient demonstrates as a result of interventions that the nurse plans, and which the nurse and the patient implement collaboratively. The nurse-counselor's role is not merely to facilitate the discharge of energy related to anxiety, loneliness, guilt, fear, and other emotions, but to enable the patient to use these feelings to learn something worthwhile as a result of the experience. Over the years nurses have worked with patients and facilitated their efforts to live emotionally healthier and more comfortable lives. 
13 
Clinically Observed Behaviors in Schizophrenic Patients 
In 1911, Bleuler2 coined the term "schizophrenia" to describe the schism between thinking and feeling. Bleuler classified schizophrenia into primary and secondary symptoms. The primary symptoms, known as Blueler's four A's include: autism, associational disturbance, affective disturbance, and ambivalence. The secondary symptoms are denoted by delusions, hallucinations, illusions, withdrawal, lack of touch with reality, and muscular activity symptoms. 
In 1959, Schneider11 rank-ordered the behaviors of schizophrenics as a method of diagnosing their illness. Behaviors categorized in the first rank included: hearing one's own thoughts spoken aloud, auditory hallucinations that comment on the patient's behavior, belief that one's thoughts are controlled, belief that one can control the thoughts of others, delusions, somatic hallucinations, and belief that actions are controlled or influenced by external sources. Symptoms designated as second rank were: affective disorders, such as depression and euphoria, other hallucinations, a sense of perplexity, and emotional blunting. Schneider noted that not all symptoms need be present for the patient to be diagnosed as schizophrenic. 
The World Health Organization initiated the International Pilot Study of Schizophrenia (IPSS) 12 to develop and standardize objective criteria to be used to diagnose schizophrenia. The IPSS identified the presence or absence of the following behaviors as indicative of schizophrenia: bizarre--nihilistic--widespread delusions, incoherent speech patterns, hearing thoughts spoken aloud, restricted affect, lack of facial expression, inability to experience pleasure, no early waking, limited or absent insight, poor rapport, and inability to give an accurate history. 
In recent years, schizophrenic symptoms have been more closely linked to biological etiological factors. 10 The course of Positive Symptom Schizophrenia is described as having an acute onset, good premorbid functioning, reasonably intact social functioning, with exacerbations and remissions. The positive symptoms are abnormal or excessive mental operations, such as: hallucinations, delusions, bizarre behavior and agitation, formal thought disorder, and inappropriate affect. MRls indicate that these individuals have normal brain structure. They respond well to traditional neuroleptic medications and do not demonstrate a cognitive deficit. Individuals exhibiting Negative Symptom Schizophrenia often have enlarged brain ventricles, are more responsive to the newest neuroleptic medications, and exhibit cognitive impairment. Negativesymptom schizophrenia has an insidious onset, a history of poor premorbid performance, and a deteriorating and/or chronic course. 
14 
Negative-symptom schizophrenics demonstrate alogia, poverty of speech, flat affect, apathy, markedly decreased attention, and anhedonia. 
Today, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition1 describes the following symptoms as being diagnostic of schizophrenia: hallucinations, delusions, disorganized speech patterns (characterized by incoherence or frequent derailment), catatonic or severely disorganized behavior, and negative symptoms such as alogia, avolition, and flattening of affect. Schizophrenic individuals experience disturbances in the social and occupational components of their lives, difficulty with interpersonal relationships, and a marked decrease in self-care ability. 
Expected Goals of Inpatient Treatment 
Milieu therapy in the traditional hospital setting focused on three goals: (a) Resocialization, teaching patients new ways of relating to themselves, others, and their environment (accomplished by nurses through role-modeling and psychoeducation); (b) Ego Development, or strengthening (which descended from the nurse's support and clarification); and (c) Prevention or reversal of the regressive effects of hospitalization. Prior to the institution of Milieu therapy, long-term hospitalization was implicated in causing patients to become more helpless than they were at the time of admission. The structure of authority and decision-making in the hospital environment left patients without realistic problem-solving functions. Patients were defined by their illness; and regressed behaviors in toileting, eating, and interactions were accepted and expected. 
The move to short-term hospitalization requires modification of the milieu principles, and the functions of the nurse will need to be altered to achieve new goals. Due to short-term hospitalization, the current hospital setting is characterized by an increasing number of seriously mentally ill patients. These patients tend to be difficult and more dangerous, since their symptomology tends to be more florid. The goals of short-term hospitalization are limited and include: reducing or eliminating the most severe symptoms; developing useful coping abilities, or reestablishing previous coping abilities; instilling a sense of hope about the treatment process and about future functional abilities; gaining confidence in the ability of the professional staff to be helpful; and acquiring knowledge about appropriate community resources, and learning how to access these once discharged from the hospital.7 
15 
Logotherapeutic Approach 
This final section outlines a framework for progression of the schizophrenic patient through a contemporary short-term hospitalization. Next is a discussion of a logotherapeutic approach that can be structured by the nurse to help the patient progress through the hospitalization. Finally, a table is presented that integrates the progression framework with the logotherapeutic approach and with the patient goals of short-term hospitalization. 
The current practice of short-term hospitalization challenges the nurse to develop and utilize strategies that will help the patient achieve circumscribed goals. Frankl asserts that "being human means being conscious and being responsible. "3• P·5 Although patients with schizophrenia and other psychotic disorders experience severe symptomology which makes it difficult to exercise responsibility, difficult does not mean impossible. When the patients are admitted to the hospital, their symptoms are florid: they are internally focused and demonstrate little understanding of responsibility. In the throes of their illness, they are not empathic and demonstrate only minimal responsibility for simple activities of daily living: responsibility of a higher order, such as decision-making is virtually absent. During this phase, the nurse must take responsibility for those aspects of living which the patients are not performing. 
During the midpoint of the patients' hospitalization, the relationship between patient and nurse undergoes some subtle changes. The florid symptomology that marked the admission phase of the hospitalization is diminished. While patients may still experience some hallucinations or delusional thinking, the symptoms are not as intrusive or overwhelming as earlier. They can now experience some component of shared consciousness with the nurse, although they remain internally focused. They are now capable of exhibiting some self-control and should be able to demonstrate some acceptance of responsibility for self-care and simple decision-making. The nurse continues to be an integral part of the patients' environment, using techniques to enable the patient to demonstrate more healthy behaviors. 
At the time of discharge the florid symptomology should no longer exist. The patients are more externally focused. Nurses are able to relinquish their role as acute caretakers and are able to be involved in an interactional process that requires the patients to exhibit sufficient selfcare behaviors and responsibility to be discharged into the community. 
16 
A logotherapeutic approach can be used by nurses to help in this patient progression during short-term hospitalization. It consists of four steps previously outlined by Lukas8 : 
•Distancing 
from symptoms. Frankl emphasizes that the patient is not his or her symptoms. When a patient experiences florid symptomology, the nurse can help the patient perceive that the patient and the symptoms are not one and the same. By administering neuroleptic medication the nurse acknowledges the biological component of the patient's illness. The nurse accepts responsibility for reducing environmental stimuli that heighten the patient's symptoms. Dereflection can be used to help focus away from symptoms. Paradoxical intention also can be used during this time. Frankl provides an example: a schizophrenic patient experiencing frightening auditory hallucinations claimed he could not sleep and asked for sleeping pills. The therapist asked if the patient had tried ignoring the voices. The patient responded that this had proven ineffective. The therapist told the patient to go to his bed and pay attention to the voices. "Don't let them stop. Try to hear more and more." The patient expressed incredulity, but was willing to try. Forty-five minutes later, the therapist found the patient asleep. The following morning the therapist inquired of the patient how he had slept, and the patient replied, "Oh, I slept alright," and responded that he didn't hear the voice for long because "I think I fell asleep soon."4 ·P·143 

•Modification 
of attitudes. The nurse acts as a midwife, assisting the patient to bring out what already exists, but which the patient has been unable to acknowledge. During this part of the interaction, nurse and patient enter upon a journey to discover how the patient feels about their self. The goal of this journey is to support the patient in mastering the sense of helplessness and dependency, confronting the life situation, accepting the fact that they have a serious mental illness, and strengthening the desire to be healthy where possible. 

•Reduction 
of symptoms. After the patient's attitudes have been modified, symptoms become more manageable or recede. With a serious mental illness, such as schizophrenia, the prognosis is uncertain. Nurses cannot promise that the patient's course of illness itself will not go downward, but they can help the patient face the future with hope and courage in spite of illness. While acknowledging that schizophrenia is a serious illness, the patient can be taught how to recognize stressors and learn to listen to mind and body messages, such as anxiety, fear, nervousness, boredom, and sadness. 

•Orientation 
toward meaning. Assuming that the reduction of symptoms has been accomplished, the patient is now open to engaging in new experiences. It is during this phase that illness prophylaxis is undertaken. The nurse can focus on continuing the teaching and learning process which was begun during the symptom-reduction phase. Emphasis is placed on awareness of the patient's own stressors and feelings that indicate distress, and also ability to seek appropriate assistance, whether in or out of the hospital. A healthier level of functioning would have the patient employing logotherapeutic techniques to reduce or eliminate the distress. The nurse gradually becomes less involved in the patient's decision-making as the patient becomes more responsible. Ultimately the nurse is no longer needed and the patient can write his or her own life script. 


17 
Integration of Phases of Hospitalization and A Nurse Logotherapeutic Approach and Patient Goals of Short-Term Hospitalization 
Phases of Short-term Logotherapeutic Patient Goals Hospitalization Approach by Nurses 
Admission phase 
Middle phase 
Discharge phase 
Gaining distance from the symptoms 
Modification of attitudes 
Reducing the symptoms 
Orientation towards meaning 
Reducing or eliminating severe symptomology 
Developing or reestablishing useful coping mechanisms 
Instilling a sense of hope 
Gaining confidence in the professional staff to be helpful 
Acquiring knowledge about--and access to--community resources 
18 
CELIA WINTZ, PH.D., [2001 Holcombe Blvd., Apt. 502, Houston, Texas 77030 USA] has practiced as a psychiatric nurse for thirty years. She has worked as a staff nurse and nurse manager in a state hospital. For many years she has taught psychiatric-mentalhealth nursing at both the undergraduate and graduate level, in in-patient settmgs and in community mental health facilities. She received her Ph.D. in nursing and has just completed a post-graduate program to qualify as a Psychiatric-Mental Health Nurse Practitioner. Currently she teaches psychiatric nursing, has a smallprivate clinicalpractice, does consulting, and conducts nursing research. 
References 
1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders {4th Ed.). Washington, D.C.: Author. 
2, Blueler, E. (1911). Dementia praecox of the group of schizophrenias.. NY: International Universities Press. 
3. 
Frankl, V. (1955). The doctor and the soul. NY: Alfred E. Knopf. 

4. 
Frankl, V. (1978). The unheard cry for meaning. NY: Simon & Schuster. 

5. 
Jones, M. (1953). The therapeutic community: A new treatment method in psychiatry. NY: Basic Books. 

6. 
Jones, M. (1968). Beyond the therapeutic community. New Haven: Yale University Press. 

7. 
LeCuyer, E. (1992). Milieu therapy for short-term stay units: A transformed practice theory. Archives of Psychiatric Nursing, vi(2), 108-116. 

8. 
Lukas, E. {1979). The four steps of logotherapy. In J. 8. Fabry, R. 


P. Bulka. & W. S. Sahakian (Eds.), Logotherapy in action (p. 95103). NY: Jason Aronson. 
9. 
Peplau, H. (1952). Interpersonal relations in nursing. NY: G. P. Putnam, Sons. 

10. 
Pfohl, 8., & Andreasen, N. (1986). Schizophrenia: Diagnosis and classification. In A. Frances & R. Hales, (Eds.), Psychiatry update. Washington D. C.: American Psychiatric Press. 

11. 
Schneider, K. (1959). Clinical psychopathology. NY: Grune & Stratton. 

12. 
World Health Organization (1973). Report of the international pilot study of schizophrenia, vol. 1 . Results of the initial evaluation phase. Geneva: Author. 


19 
The International Forum for Logotherapy, 199 7, 20, 20-2 7. 
LOGOTHERAPY IN COUNSELOR EDUCATION: IMPORTANT BUT NEGLECTED 
Kent Estes 
(ABSTRACT) Logotherapy's relevance to counselor education is discussed. A review is presented of spiritual/religious/logotherapy literature found in the official journal of the American Counseling Association. The review suggests that little professional dialogue exists m the counselor education literature concerning a theoretical framework related to spiritual and religious issues. 
"A well-known psychiatrist once 
remarked that western humanity has turned from the priest to the doctor. Another psychiatrist complains that nowadays too many patients come to the medical man with problems which should really be put to a priest. "6, p.xv Spiritual and religious concerns are important issues facing many people seeking professional counseling. 2'8 Kelly14 suggests that religion and spirituality are valid and important componentsof counseling, 

and thus need to be an integral part of the education of counselors. But, Kelly's conclusion from a recent national survey of counselor education programs is that religious and spiritual values are not emphasized in many graduate training programs. The findings identify a "low occurrence of religious-spiritual 
234 235
issues in counselor education curricula... "14' P--As a result he 
advocates: . . . it seems reasonable to recommend that the counseling profession, and counselor educators in particular, might beneficially expand research and professional dialogue to include whether and how a consideration of religious and spiritual issues needs to occur as a regular part of counselor preparation.14,P· 235 
20 
Research linking spirituality and religious issues with professional counseling and counselor education is important and timely. The study of these issues must be promoted if the counselor education profession is to continue to develop and better serve humankind. 
Frankl has created a theoretical framework and has promoted research and dialogue in this area. He has been a pioneer in concern with the psychotherapeutic importance of the spiritual dimension5, publishing related case studies as early as 1939.7 He wrote: 
Man lives in three dimensions: the somatic, the mental, and the spiritual. The spiritual dimension cannot be ignored, for it is what makes us human.... A psychotherapythat not only recognizes man's spirit, but actually starts from it may be termed logotherapy. In this connection, logos is intended to signify "the spiritual" and, beyond that, "the meaning"... the goal of psychotherapy is to heal the soul, to make it healthy; the aim of religion is something essentially different--to 
save the soul.6• p.xv,-xx, Logotherapy provides an authoritative point from which to extend the research and professional dialogue in response to these critical issues related to counseling, spirituality, and religion. Yalom recognizes the uniqueness of Frankl's work when he writes, "Few clinicians have made any substantial contributions to the role of meaning in psychotherapy... Viktor Frankl is the single exception, and from the beginning of his career, his professional interest has focused exclusively on the role of meaning in psychopathologyand therapy. "31 • P-92 Gould describes logotherapy as " ... a bridge between existential psychotherapy and humanistic psychology. It redefines the existential emphasis on choice, freedom, and responsibleness while maintaining the humanistic appreciation of rationality and the fundamental assertion that the self is more than the sum of its parts."11 • P-5 Welter captures the contributionsof Frankl and logotherapy specifically when he states: Traditional medicine has ministered to the body. Psychology has been useful in helping us understand the human mind. Frankl, trained both in medicine and psychology, has gone beyond them to emphasize ... the spiritual dimension of humankind. It is from our spiritual nature that the will to meaning springs... This point of view has immense implicationsfor counselors. It implies 
21 
that meaning does exist in life, and that the counselor should be an authentic part of the search for that meaning. The stakes are high in that quest. If the search is successful, the client will experience a sense of usefulness and joy. If the search is a failure, the client may encounter one or more of several negative 
29 31
consequences. · P-
Welter demonstrates the relevance of logotherapy when he refers to Frankl's concept of the mass neurotic triad--depression, addiction, and aggression--and the relationship to a sense of meaninglessness: "Never have we had more depressed, addicted. and violent people than we have today... The evidences are compelling that 
24 25
meaninglessness is a widespread epidemic."29• P-· Examples of the usefulness of logotherapy as a supplemental therapy in response to these negative consequences can be found throughout The International Forum for Logotherapy. The Spring 1991 issue, for example, discusses the following topics from the context of logotherapy:hysteria, multiple personalitydisorder, the disabled, stress management, and marital therapy. The Autumn 1994 issue provides information related to logotherapy and the following topics: bereavement groups, chronic headache and conflict resolution, and AIDS. These articles offer evidence that logotherapy is relevant to today's human suffering as a counseling approach. 
The following study explores the extent to which logotherapy has been written about by professional counselors. Professional counselors in the United States are practitioners who have completed a prescribed course of counseling study leading to a master's or a doctorate degree. Professional counselors are primarily concerned with the developmental and situational concerns of persons. 
One would expect to find numerous articles in the literature documenting the influence Frankl has had on the profession and on counselor education. That is not what was found. 
Method 
The Journal of Counseling & Development (the official journal of the American Counseling Association) was selected as representative of the dialogue within the counseling profession. September 1984 through April 1994 (volumes 63-72) were reviewed to identify: 
22 
1. 
Articles related to religion and/or spirituality. 

2. 
Specific articles related to logotherapy and/or Viktor Frankl. 

3. 
References that cite logotherapy or Frankl. 


Results 
Seventy-two journals (more than 1600 articles and thousands of references) were reviewed to determine the extent of the influence in professional counseling and counselor education made by logotherapy and Viktor Frankl. The results are: 
1. 
One article was found about logotherapy.23 This, the only article found, was written more than 10 years ago and was never referenced in any other of the articles reviewed. 

2. 
Twelve articles referenced Frank1.2,4,12,13,15,16,19,21.23,24,25,21 

3. 
Two articles referenced other logotherapy authors (Crumbaugh25; Fabry26). 

4. 
Ten articles dealt with religion/spirituality but were unrelated to logotherapy.,,3,8,9,, o., 1. 10.22.20,30 


The one article and 13 referencings found that were related to logotherapy suggest this theoretical approach is neither being applied nor is it recognized within the professional counseling dialogue. 
Discussion 
More than 10 years ago Ruffin promoted the importance of 
logotherapy to the counseling profession when she wrote: The evidence presented here clearly substantiates the hypothesis that the anxiety of meaninglessness is a significant human problem... a problem of increasing proportions, and according to Frankl it constitutes a large percentage of present-day case loads. Therefore, counselors must discard the false notion that meaninglessness is solely the concern of philosophers and theologians... Upon recognizing the presence of meaninglessness, counselors need to develop a theoretical framework from which to proceed.23·P-42 
The present study suggests that little progress has been made in advancing the professional dialogue concerning a theoretical framework related to spiritual and religious issues in professional counselor education. The work of Frankl is not being significantly considered and in some cases not even appropriately recognized. The following quotation provides one significant example of this. 
23 
"Psychology has rarely focused attention on spirituality... Transpersonal psychologists have attempted to call attention to spirituality and the 'transcendent dimension of human experience' that has been largely ignored within psychology."18·P·57 Obviously, Frankl has focused attention on spirituality and the "transcendent dimension of human experience" as a fundamental part of logotherapy.29 Frankl is not referenced in this context by these authors. 
The confusion is intensified by Allen Ivey, a highly respected, influential author and counselor educator, who when asked "Whose work do you admire?" responded, " ... I anticipate that Frankl will be recognized, over the long term, as the humanistic psychologist... Frankl seems to be the 'balanced humanist' who not only is willing to be with the client but is also willing to act in the moment to enrich being. "27· P-532 Could it be that "the humanistic psychologist" has had little influence on counselor education? 
Why isn't Frankl's theory emphasized in the professional counselor education literature and the classroom? Worthington reviewed the empirical research on religious counseling published between 1974 and 1984. The conclusions, stated below, may still be valid today: 
Throughout this article, I have been critical of much of the research investigatingreligious counseling.Although there have been some good studies, for the most part the research quality lags behind many of the subdisciplines of psychology. Research on religious counseling is a risky undertaking, only occasionally acceptable to some of the major counseling journals. Yet, if knowledge is to be advanced in the area, more researchers must accept the risks and venture into the mainstream of the methodology of counseling research.30• p.421 
This research must be promoted and logotherapy would seem to be a place to start. 
Kelly's14 national survey of 525 counselor education programs and 343 respondents, indicated that the training programs for professional counselors are not including, in any significant way, consideration of these issues as a regular part of counselor preparation. The research in this area is lacking and there is much work to be done. Logotherapy is an untapped resource for counselor educators. 
In conclusion, the study of logotherapy would lead to enhanced preparation of professional counselors. 
24 
The Jewish psychiatrist, Viktor Frankl, has been a strong spokesperson for considering a religious perspective within a secular framework. Frankl declared that the human psyche is religious by nature and that religion is indelible and indestructible, even by psychosis. He stated that psychotherapy supports this essential religious nature but that "such evidence can only be offered by a psychotherapy that is ... not and never can be religiously oriented." Frankl's logotherapy, or 'meaning therapy', does not cross the boundary between psychotherapy and religion. But it leaves the door open, and it leaves it to the patient whether or not to pass through the door.20· p.a5 
If clients choose to pass through the spiritual/religious door, professional counselors need to be equipped to accompany them. 
KENT ESTES, ED.D. [Dept. of Counseling and School Psychology, University of Nebraska at Kearney, Kearney, Nebraska 68849 USA] is Department Chair and Associate Professor, a Nationally Certified Counselor, and a State Certified Professional Counselor. Dr. Estes received the Diplomate in Logotherapy in 1995. He is primarily engaged in counselor education. 
References 
1. 
Celmer, V., & Winer, J. (1990). Female aspirants to the Roman Catholic priesthood. JournalofCounseling & Development, 69, 178-183. 

2. 
Chandler, C., Holden, J., & Kolander, C. (1992). Counseling for spiritual wellness: Theory and practice. Journal of Counseling & Development, 71, 168-175. 

3. 
Dattilio, F. (1987). The use of paradoxical intention in the treatment of panic attacks. Journal of Counseling & Development, 66, 102-103. 

4. 
Debord, J. (1987). Paradoxical interventions: A review of the recent literature. Journal of Counseling & Development, 67, 394-398. 

5. 
Frankl, V. (1984). Man's search for meaning. NY: Washington Square Press. 

6. 
Frankl, V. (1986). Thedoctorandthesoul. NY: Vintage Books. 

7. 
Frankl, V. (1992). The first published cases of paradoxical intention. The InternationalForum for Logotherapy, 15, 2-9. 

8. 
Genia, V. (1994). Secular psychotherapists and religious clients: Professional considerations and recommendations. Journal of Counseling & Development, 72, 395-398. 

9. 
Goldberg, A. (1991 ). Being Jewish in America: A response to Weinrach. JournalofCounseling & Development, 70, 344-346. 

10. 
Gould, N. (1990). Spiritual and ethical beliefs of humanists in the counseling profession. Journal of Counseling & Development, 68, 571-574. 


25 
11. 
Gould, W. (1993). Frankl--life with meaning. Belmont, CA: Wadsworth. 

12. 
lshiyama, F. (1987). Use of Morita therapy in shyness counseling in the west: Promoting clients' self-acceptance and action taking. Journal of Counseling & Development, 65, 547551. 

13. 
lshiyama, F. (1990). A Japanese perspective on client inaction: Removing attitudinal blocks through Morita therapy. Journal of Counseling & Development, 68, 566-570. 

14. 
Kelly, E., Jr. (1994). The role of religion and spiritually in counselor education: A national survey. Counselor Education and Supervision, 33. 227-237. 

15. 
Lucas, C. (1985). Out at the edge: Notes on a paradigm shift. Journal of Counseling & Development, 64, 165-1 72. 

16. 
Lyddon, W. (1987). Root metaphor theory: A philosophical framework for counseling and psychotherapy. Journal of Counseling & Development, 67, 442-448. 

17. 
Morrow, D., Worthington, E., Jr. & McCullough, M. (1993). Observers' perceptions of a counselor's treatment of a religious issue. Journal of Counseling & Development, 71, 452-456. 

18. 
Myers, L., Speight, S., Highlen, P., Cox, C., Reynolds, A., Adams, E., & Hanley, C. (1991 ). Identity development and world view: Toward an optimal conceptualization. Journal of Counseling & Development, 70, 54-63. 

19. 
Newton, G., & Dowd, E. (1990). Effect of client sense of humor and paradoxical interventions on test anxiety. Journalof Counseling & Development, 68, 668-672. 



26 
20. 
Ouackenbos, S., Privette, G., & Kientz, B. (1985). Psychotherapy: Sacred or secular? Journal of Counseling & Development, 63, 290-293. 

21. 
Ouackenbos, S., Privette, G., & Kientz, B. (1986). Psychotherapy and religion: Rapprochement or antithesis? Journal of Counseling & Development, 65, 82-85. 

22. 
Ritter, K., & O'Neill, C. (1989). Moving through loss: The spiritual journey of gay men and lesbian women. Journal of Counseling & Development, 68, 9-15. 

23. 
Ruffin, J. (1984). The anxiety of meaninglessness. Journal of Counseling & Development, 63, 40-42. 

24. 
Speight, S., Myers, L., Cox, C., & Highlen, P. (1991 ). A redefinition of multicultural counseling. Journal of Counseling & Development, 70, 29-36. 

25. 
Stevens, M., Pfost, K., & Wessels, A. (1987). The relationship of purpose in life to coping strategies and time since the death of a significant other. Journal of Counseling & Development, 65, 424-426. 

26. 
Tennyson, W ., & Strom, S. (1986). Beyond professional standards: Developing responsibleness. Journal of Counseling & Development, 64, 298-302. 

27. 
Weinrach, S. (1987). Microcounseling and beyond: A dialogue with Allen Ivey. Journal of Counseling & Development, 65, 532-537. 

28. 
Weinrach, S. ( 1994). Closing one chapter and opening another: An existential search for meaning or underwear that fits. Journal of Counseling & Development, 72, 438-439. 

29. 
Welter, P. (1987). Counseling and the search for meaning. Waco, TX: Word Books. 

30. 
Worthington, E., Jr. (1986). Religious counseling: A review of published empirical research. Journal of Counseling & Development, 64, 421-431 . 

31. 
Yalom, I. (1983). The "terrestrial" meaning of life. The InternationalForum for Logotherapy, 5, 92-102. 


27 
The International Forum for Logotherapy, 199 7, 20, 28-36. 
FINDING MEANING THROUGH FRANKL'S SOCRATIC DIALOGUE AND FROMM'S FIVE NEEDS OF THE HUMAN CONDITION: A GROUP PROCESS FOR SCHOOL COUNSELING 
Robert A. Wilson 
Frankl' s Socratic dialogue is a useful counseling and guidance technique for the school counselor; it is also a useful problem-solving and communication strategy for the classroom teacher.6 In the over-all implementation of the logotherapy process, Erich Fromm's five needs of the human condition can play a relevant role. 
The following article presents a 1 0-session group process built upon the compatability between Socratic dialogue and Fromm's five needs of the human condition. The process helps students discover responsibility, transcendence, and the needs of the human condition. It also strengthens their ability to make crucial value/life decisions. 
Logotherapeutic Approach 
Frankl' s approach is functional and appropriate within the educational milieu, which has been discussed elsewhere with specifics.6 The Meaning Triangle is the vehicle by which the principles of logotherapy are related. 

28 
MEANING -...TRIANGLE 
ATTrfVDI'.'IAL "Acceptance of an unchangeable fate" "The stand we take toward a fate we can't change" 
MBANJINO 
,/CREATIVE  EXPERIENTIAD,  
"\Vhat we give to life"  "\Vhat  we  take from life"  
"Accomplishment"  "Experiencing others,  love,  art,  
and nature"  

Socratic dialogue is a logotherapeutic technique that taps the healthy core, the spirit, so that utilization of its resources can be enhanced. Fabry2 has pointed out five circumstances that Socratic dialogue can especially illuminate to lead to meaning: 
• 
Self-discovery--situations in which you discover a truth about yourself. The insight may be triggered by an experience you have seen, heard, read, fantasized, or dreamed, but the discovery must be yours. 

• 
Choices--you are not without choice, even though you may be trapped. Frankl has said: "The conditions do not determine me, but I determine whether I yield to them or brave them. "1· p.x,x If a situation can be changed, the meaning of the moment is to change it. Even in a situation that is unchangeable you have a choice: you can change your attitude toward that particular situation. 

• 
Uniqueness--each person goes through a string of individual, unrepeatable situations. Uniqueness becomes most apparent in creative actions and personal relationships. 

• 
Responsibility--response-ability, the ability to respond to the "meaning offerings in each new situation." Meaning results from taking responsibility in situations that you can control, and from not taking responsibility in situations you cannot change. 

• 
Self-Transcendence--commitments that transcend personal interest toward causes or service or people to love. Frankl sums it up: "One of the main features of human existence is the capacity to emerge from and arise above all conditions--to transcend them. By the same token, man is ultimately transcending himself."3• P· 61 


29 
Combining Fabry' s five guideposts for Socratic dialogue with Fromm's five needs of the human condition can form a pathway in discovering Frankl' s three ways to find meaning. The blending of Frankl' s Socratic dialogue with Fromm's five needs of the human condition provides a viable process to shine greater light on each student's journey to meaning. 
Fromm's Five Needs of the Human Condition 
•Relatedness--Fromm 
defines the Need for Relatedness as actively and productively loving others. Productive love implies caring, responsibility, respect, and knowledge. If I love, I care: I am actively concerned with other persons' growth and happiness. If I am responsible, I respond to their needs. If I respect them, I look at them as they are, objectively--not distorted by any wishes and fears. If I know them, I have penetrated through their surface to the core.4· P-33 

•Transcendence--Humans 
alone "are aware of being created and of being the creator. "4 ,P· 37 They raise themselves "beyond the passivity and accidentalness of their existence into the realm of purposefulness and freedom. "4 · P-37 

•Rootedness--Human 
beings need to feel a sense of connectedness with the world, nature, and others. According to Fromm, humankind fears the severance of natural roots: where are we? who are we? If we lose our roots, we "stand alone, without a home; without roots, we could not bear the isolation of helplessness. · P· 38

"4 

•ldentity--To 
make sense out of the world, humankind--being torn away from nature, being endowed with reason and imagination--needs 


60 61
to form a concept of self. Humans need to say and to feel/ am /.4• P· The need is so vital that humans could not remain sane if they do not find some way of satisfying it.4• P· 61 
•Frame of Orientation--Because we have reason and imagination, we have a need for orienting ourselves in the world intellectually: for finding a stable way of making sense of the world. We find ourselves surrounded by many puzzling phenomena, and have a need to put them in some context which we can understand.4· P·64 
30 
The Process: Socratic Dialogue/Human Condition Paradigm 

(SPIRITUAL) " ceptance for an unchangeable "not to do what you want-but what is called for" 
SOCRATIC NEEDS ~fflTMAN DIALOGUE CONDITION 
Self-Discovery Need for Rootedness 
Uniqueness Need for Identity 
Responsibility Need for Relatedness 
Choices Need for Frame of Orientation 
Self-Transcendence Need for Transcendence 
~~~EJbtlt.uIJ.T'l~E--------------------ll:P!lilUENTlAP 
~-~ ~-~~~~ 
Accomplishment Experiencing othen; 
Socratic dialogue represents mutuality and interchange, but also individuality and autonomy. "The students do not try to solve problems for each other. The discovery of meaning remains the responsibility of the individual. Each student's search for meaning must remain personal, 
"2
and care must be taken to avoid peer pressures within the group. • P-113 
31 
Ten Group Sessions 
Session 1 
Self-discovery. Questions, statements, and activities pertaining to self-discovery are discussed. Questions: Who are you? What do you want to become? What have you recently discovered about yourself? 
Need for rootedness. Discuss the importance of the need for rootedness. What does rootedness mean? What would happen if you didn't have roots? Where did you come from? Who is your family? How big is your immediate family? your extended family? (Some of these questions are given as home work. Home work is assigned at the end of every session and then discussed at the beginning of the next.) 
Session 2 
Self-discovery. How did you apply self-discovery during the week? Questions: Tell about a time that you trusted yourself. What is your favorite mask? What are four things you know about yourself that someone else doesn't know? Would you like to share something about yourself? 
Need for rootedness. What do you know about your family? your "family tree"? Tell about the characteristics of your family members. What is important about your mother? father? brother? sister? grandparents? aunts/uncles? cousins? What about the roots of other people? your friends? other cultures? 
Session 3 
Uniqueness. You will find meaning when you recognize you are special in some way. Fabry suggests that "creativity is a guidepost to uniqueness and meaning. • P-68 Frankl defines love as the ability to see
"2 the uniqueness and potential of others who may not be aware of it, and the capacity and insight to assist others in fulfilling those potentials. 2 • P-59 These statements are useful to begin dialogue. Need for identity. Humans can be defined as "animals that can say 'I,' that can be aware of myself as a separate unity. · p.so Dialogue and 
"4 questions are generated from this statement. 
Session 4 
Uniqueness. Talk about your abilities and your special qualities. Talk about your dreams. What would you like to do? Who are your role models?--why? What is important to you? 
Need for identity. The degree to which humankind is aware of self as a separate person is dependent on the extent to which that person 
32 
has emerged from the group (clan) and the extent to which the process of individuation has developed.4 · p.a, What makes you different from the group? What makes you like the group? The important aspect of dialogue here is being part of the group, yet maintaining your own individuality and autonomy. 
Session 5 
Responsibility. Dialogue on the following statements: "We want to find meaning by personal choices that express our true and unique selves. But if those choices are not made responsibly, they will not be fulfilling." Discuss the three pathways to find meaning through responsibility: "by responding to the meanings of the moment, by making responsible choices where choices exist, and by not feeling responsible when there is no choice. "2· P•79 
Need for relatedness. This need covers productive love which always "implies a syndrome of attitudes; the need for caring, responsibility, respect and knowledge. "4 • P-33 Without these attitudes one cannot love maturely and productively. Questions about these four needs provide enough material for dialogue for several sessions. 
Session 6 
Responsibility. Key dialogue question: "How do you know whether the drumbeat is that of your conscience or egoism?" One can find the answer to his question by searching and pursuing the consequence of either choice. What are the consequences of following societal values? What are the consequences of going against those values? Are you prepared to take the consequences of your choice? Are compromises possible--do they offer solutions you can live with?2• p.s, 
Finding meaning results from taking responsibility in situations that you can control, and from not taking responsibility in situations that you are unable to control.2· P-92 Elisabeth Lukas has developed a five-step approach to problem solving that is effective from elementary through college: (a) What is your problem? (b) Where is your area of freedom? (List aspects over which you have control and aspects that you have to accept.) (c) List your choices within your area of freedom. (d) Which of these choices is the most meaningful to you? (e) What is your first step in the direction you have chosen ?2• P 84 
Need for relatedness. During this phase we continue to explore the areas of caring, responsibility, respect, and knowledge. Statements to probe in the dialogue are: If I love, I care. If I am responsible, I respond to the needs of the person. If I respect (re-spicere) "I look at the person 
33 
"4
as he/she is, objectively and not distorted by my wishes and fears. • P• 33 If I know the person, "I have penetrated through the surface to the core of his/her being and related myself to him/her from my core, from the center, as against the periphery, of my being. • P-33
"4 
Session 7 
Choices. Quite often we are not aware of the choices we do have. This concept is most relevant to relate to the Meaning Triangle for timely and meaningful dialogue. 
Need for a frame of orientation. Not only do we need to have our own sense of identity but also to orient ourselves in the world intellectually. "The further his reason develops, the more adequate becomes the person's system of orientation, that is, the more it approximates reality. "4· P·63 The more the human being develops objectivity (to see the world and ourselves not distorted by desires and fears), the more we are in touch with reality, and the more we mature, the better we can create a human world in which home becomes a reality.4· P·64 This whole subject can be approached through a questioning dialogue. 
Session 8 
Choices. When you become aware of the fact that you have choices and of the impact the choices have, you come closer to meaning. Fabry' s Guideposts to Meaning2 contains many exercises, activities, and questions that orbit around the ability to decide. Does your choice represent your true self, or is it based on a "should" (a response to an outside demand) ?--do not automatically reject these outside demands, but examine each one to determine if you agree with it. 
Need for a frame of orientation. "Reason must be practiced, in order to develop, and it is indivisible. Objectivity refers to the knowledge of nature as well as to the knowledge of humankind, of society, and of oneself. We need to be in touch with reality by reason, to grasp the 
64 55
world objectively. "4· P-· "To be objective, to use one's reason, is possible only if one has achieved an attitude of humility, and if one has emerged from the dreams of omniscience and omnipotence which one has as a child. "5• P-101 The following is a paradigm that I have used to 
explain  this  concept,  and  which  has  generated  excellent  group  
discussion:  
I ••••••••••  . Objectivity  
Self-centeredness  Reason  
Subjectivity  Humility  

34 
One can view this concept as two poles: the closer you come to the Objectivity pole, the closer you are to reason and humility and a frame of orientation. The closer you come to the I pole the closer to selfcenteredness and subjectivity, and farther away from a frame of orientation. 
Session 9 
Self-transcendence. The unique human capacity to reach beyond oneself is significant because it takes in all other areas and provides meaning in exactly the areas where you feel defeated: it turns defeat into victory.2• P-97 When you reflect on others, you gravitate away from being self-centered toward being "other-centered" which fosters a special meaning. Orienting the students to the concept of selftranscendence takes considerable time and discussion. 
Need for transcendence. Fromm views transcendence as creativeness versus destructiveness. Only the human being is aware of being created and of being a creator. "In the act of creation man transcends himself as a creature, raises himself beyond passivity and accidentalness of his existence into the realm of purposefulness and freedom. "4 • P-37 The roots for love lie in the need for transcendence, as well as for art, religion, and material production. Questions regarding creativity, beauty, ingenuity, imagination, productivity, and the dignity of humankind are appropriate for this area. 
Session 10 
Self-transcendence. Questions that deal with values and role models are relevant in discussing self-transcendence. What are the qualities you like about the people you admire? Do you take risks to help others? Do you help others when you really don't want to? Do you enjoy helping others? Do you enjoy helping others when you are paid?--when you are not paid? Do you volunteer at home? at school? at work? at church? with your friends? 
Self-transcendence as a road to meaning is available to everyone, in all circumstances, and at all ages. Its value is most evident for people who are suffering from meaningless pain and grief. Self-transcendence is achieved by anyone who "goes beyond" what is expected, and does any kindness that comes naturally.2• P-92 
Need for transcendence. According to Fromm, there is another answer to the need for transcendence: "If I cannot create life, I can destroy it. To destroy makes me also transcend it. · P-37 "Thus, the
"4 ultimate choice for man, inasmuch as he is driven [Frankl would say "as 
35 
he chooses"] to transcend himself, is to create or destroy, to love or to hate... Creation and destruction, love and hate, are both answers to the same need for transcendence, and the will to destroy must rise when the will to create cannot be satisfied. However, the satisfaction of the need to create leads to happiness; destructiveness to suffering, most of all, for the destroyer himself. · p.37-3 s
"4 Write a one-page paper on "If we can't create, we will destroy." Questions regarding creativity are significant here. Questions such as: What are things you create in school? Do you create things at home? What are your special talents? Do you have an opportunity to share these talents with others? What are your hobbies? What do like that others have created? 
ROBERT A. WILSON, Ph.D. [Fresno Pacific College, 1717 Chestnut Avenue, Fresno, California 93702 USA] is a Dip/ornate in logotherapy, Director of School Counseling and Pupil Personnel Services, Fresno Pacific College, Fresno, California. He is former Director ofPsychological Services, Fresno Unified School District. 
References 
1. 
Fabry, J. (1968). The pursuit to meaning. Boston: Beacon Press. 

2. 
Fabry, J. (1988). Guideposts to meaning. Oakland: New Harbinger. 

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

4. 
Fromm, E. (1962). The sane society. NY: Holt, Rinehart, & Winston. 

5. 
Fromm, E. (1974). The art of loving. NY: Harper & Row. 


6. Wilson; R. A. (1994). Logotherapy in the classroom. The International Forum for Logotherapy, 17, 32-41. 
36 

The International Forum for Logotherapy, 199 7, 20, 37-45. 
ADDICTION RECOVERY: TRANSCENDING THE EXISTENTIAL ROOT OF RELAPSE 
Patricia E. Haines 
Existential frustration and the inability to find avenues to meaning in all life's events are culprits in relapse. When looking at the dynamics of drug and alcohol relapse, the role of existential frustration 1s evident. 
A turning point in the relapse process is the point when people come to recognize that life is short and they do not want to waste it by living an empty existence. If this transition occurs, they live; if it does not, they die--perhaps not physically, but emotionally and spiritually. 
Four dynamics are operational in recovery: (a) abstinence, (b) personal spiritual recovery program, (c) personal vigilance and responsibility, and (d) the pursuit of personal meaning. These do not occur in a hierarchy, but rather simultaneously on the journey to recovery. 
Recovery will be successful and quality of living will be established only when recovering people realize the essential need to attend to finding personal meaning. Therefore, avenues to meaning must be intrinsic in any recovery program, not alluded to as an incidental or adjunct consideration. Meaning facilitates a permanent transition into recovery. 
A most important aspect of recovery from substance abuse is to prevent relapse. Even though relapse is considered part of the illness, most relapse stems from lack of diligence in attending to maintaining meaning and purpose along with the nurturing of spiritual, physical, and mental aspects of recovery. This regimen of recovery must be practiced each day, much in the same fashion that the patient recovering from heart surgery must exercise and eat properly daily to 
37 
prevent return of the pathology. In other words, meaningful recovery and personal responsibility are forever tied together. 
Often those who relapse do not consciously know the reason. But, upon questioning, they speak of emptiness, an internal void. "Sobriety isn't what I thought it was cracked up to be." Something is not right. They admit that much of their surface "happiness" was a pretense. The facade that they were "all together," covered underlying depression, anger, loneliness, and emotional fatigue. Even when they tried to do everything they were asked to do in recovery, the result was less than satisfying. Holmes stated, "Beyond all psychological explanations for alcohol addiction... and beneath all physiological explanations... I have found, as the major frustration, the inability to find meaning. · P-243
"3 
Existential Root of Relapse 
The existential root of relapse encompasses the following behaviors, thoughts, and feelings: 
•Meaninglessness 
and emptiness in sobriety. When sobriety is nothing more than being dry, with no meaning, relapse will occur eventually. Recovering persons often say, when they become miserable in sobriety they might as well be miserable drinking and using. 

•Poor 
self image. Persons who see themselves as having no purpose or value believe they are too worthless to have the gift of recovery. Therefore, they realize the self-fulfilling prophecy of their unworthiness by relapsing. 

•No 
vision for the future. When people in recovery develop no real mission in life, and they have no future or vision, then substance use brings momentary relief. 

•Self 
absorption. Persons who spend their time continually contemplating themselves ignore one of the fundamental avenues to meaning--focusing outward and giving the world their talents to make it a better place. They become all-consumed with what is happening to them and do not really care about the contributions they can make to society. 

•Greater 
comfort in chaos. Some people look upon chaos and dysfunction as synonymous with excitement. So, when life is too calm, they create the chaos for excitement. But, this type of excitement leads to suffering and pain. 

•Allowing 
suffering and pain to gain the upper hand. Some individuals truly believe they cannot withstand suffering unless they use substances to ease the hurt. People fear pain and convince themselves they are powerless. Lukas has some thoughts on people who strive to avoid pain: 


38 
The more they escape reality, the weaker their strength to bear it. The drug undermines their defiant power, weakens their will power, clouds their responsibility, and destroys their freedom to make choices. It blocks their human dimension and, once this happens, they really are victims of reduction. They are reduced to persons controlled by the amount of the drugs in their blood.4·P ;14 
•Failure to take personal responsibility. Finding paths to meaning takes effort. The recovering person has responsibility to find personal meaning that makes recovery rewarding. 
•Magical 
thinking. Some believe that in sobriety the trials and tribulations of life will disappear. They believe that when they are leading a sober life and "being good," they should be exempt from the realities of life itself. They become disillusioned when this turns out otherwise. 

•Dwelling 
on the past. Vision, meaning, and missions are not possible for people who hold onto hurts and resentments. This is especially true when individuals focus on violations and view themselves as hopeless victims. 


A Case 
Rob, 28, struggled early in recovery, then seemed to embrace sobriety. He attended AA meetings regularly, abstained from drinking, helped others, and appeared to be making significant changes in his life. His relationship with Sarah, on which he focused almost entirely as his meaning for living, had improved dramatically. Then, Sarah decided she wanted some space and time to work on herself. Rob's demeanor changed noticeably. He still went through the motions of working a recovery program, but something was definitely missing. The smile was gone and his eyes were empty. The spark had disappeared. His meaning went out the door with Sarah. Disillusioned in sobriety, and having no real vision for the future, Rob drank and used drugs again. He hit bottom quickly. 
He returned to treatment in complete despair. Life was meaningless drunk or sober. He contemplated suicide. Rob was helped to 
39 
understand the concept of meaning and what he could do to find it. After months of diligent effort, Rob invested in doing something he had never done before--searching for meaning for himself. When he recognized that he was worthwhile as a person and had a purpose all his own, his recovery began to have personal meaning. To this day, he has not relapsed again. 
Invading and Conquering the Existential Root of Relapse 
Invading and conquering the existential root of relapse can be facilitated through affirmations or reaffirmations of self. Some that I have found most useful are presented below. 
I am someone 
Often low self-esteem follows people into recovery. Occasionally, substance abusers believe that the use of substances makes them feel good about themselves. In recovery when they have periods of feeling personally inadequate, they can be lured into using chemicals to feel temporarily inflated. However, the good feelings are short lived, and the user soon experiences despair. 
AFFIRMATION: I am someone. I have meaning and purpose. My life is worth something. I am loved and am capable of loving. By the very fact that I am part of creation, I am someone. 
I am an adult 
There is a saying: Substance abusers stop maturing when the abuse began. This is why so many recovering people are "30 going on 10." A gigantic gap exists between the chronological age and the level of maturity. 
AFFIRMATION: I am an adult. I must grow up. If I am to live successfully I have to learn to think and act like an adult, to make adult decisions. I let go of my magical thinking and focus on relying on my defiant spirit to deal with life on adult terms using rational thought. I am an adult. 
40 
I have something special to give 
Substance abusers are so used to taking, many have not thought about giving to anyone. Members in a 12-step fellowship say: We have to give it away to keep it--the greatest insurance to prevent relapse is the act of sharing one's path to recovery, reaching out to help someone else. Frankl, even when he was embraced by fear and uncertainty in the camps, reached out to others and shared his resources with fellow prisoners.2 He realized that giving to others took the focus off his precarious situation. 
AFFIRMATION: I have something special to give. No matter how difficult life is, I reduce the anxiety by reaching out beyond myself to others. I transcend any limitations. I need to discover my missions and focus on fulfilling them, not on worry about myself. I have something special to give--me and my talents. 
I will not be vanquished 
When President John Kennedy was assassinated, a reporter asked Rose Kennedy how she managed to get through the tragedies she had endured. She replied, "I will not be vanquished." Alcoholics have learned how to manipulate to get what they want, but not to preserver with honest effort. They tend to give up when the going gets tough. In the camps, Frankl2 made up his mind that the Nazis could not take away his will to live and his will to meaning except to kill him physically. He maintained his will to meaning. He found meaning each day despite the hardships. 
AFFIRMATION: I will not be vanquished. I do not allow anything life has to offer lead me back into destruction. I look for the path to meaning in every circumstance. Every adversity has meaning potential. I will not be vanquished. 
I forgive 
Essential to recovery and to the pursuit of meaning is the cleansing of oneself from excess baggage of hate, resentment, and contemptuous feelings. Often addicts have experienced violations or believe they are victims of persecution. In order for the spirit to do its job, a person must be willing to pull on the strength within and to rid the self of any hindrances. Hate and resentment cloud the spirit. At 
41 
that moment this indomitable spirit is ignored for as long as the person holds onto the bitterness and resentment. The instant one begins to have the desire to rid oneself of the rage and to forgive the violations, the defiant spirit is available at the powerful, indestructive core once again. Crumbaugh states, "logotherapy stimulates the individual to explore each of the three types of values--creative, experiential, and attitudinal--tofind his own personal meanings. Here every logotherapist must develop specifics because Frankl leaves the system intentionally generic in this respect."1,P· 155 
AFFIRMATION: I forgive. I strive with all my being to forgive those who have wronged me. I refuse to hold onto bitterness and resentments which have haunted me. I free my defiant spirit of hindrances. I no longer nurse my wounds, but focus on healing. Then my defiant spirit is empowered. And while forgiving others, I forgive myself. I forgive. 
A Meaning in Recovery Survey 
The Haines Meaning in Recovery Survey can help clients identify their meaning strengths and weaknesses in their sobriety. This 1 instrument is most useful when given to an individual with six or more j months of sobriety. The survey is meant to be an adjunct to other . relapse checklists of symptoms of relapse. 
1 
42 
Haines Meaning in Recovery Survey 
Yes No 
I rarely think of drinking or drugging 
I have more good days than bad 
I have at least one meaningful vision for my future 
I have at least one mission now 
I have a greater appreciation of me 
I have a greater appreciation for my friends 
Life is better sober 
I notice the beauty of nature 
I have a healthy support system 
I work a daily recovery program 
My quality of life has improved 
I like who I am today 
I am grateful that I am sober and clean 
I am personally responsible for me today 
I give of my talents to other people today 
I am able to search for meaning in adversity 
43 
Complete the Following Sentences 
In my sobriety I appreciate __________________ 
I want to give to the world__________________ 
I continue to________________________ My favorite activity is____________________ I pay or ask for______________________ The most difficult thing for me is_______________ When I think of my past, !__________________ The most meaningful aspect of sobriety is____________ I really enjoy________________________ I believe in ________________________ The purpose in my life today is________________ One of my missions or callings is_______________ 
Write a Paragraph about Yourself Sober and Clean 
44 
Mission of the Logotherapist 
In Frankl's terms, the very mission of a logotherapist is to help clients find meaning in their lives. Therefore, the role of the person counseling substance abusers is to motivate those individuals to find their paths to meaningful sobriety. Meaningful sobriety is necessary for permanent recovery. Life is always in a dynamic flow; the pendulum swings. When sober life becomes boring and uninteresting, returning to substance use is more and more appealing. Boredom is a leading cause of relapse. Time and again relapsers tell stories of making it through crises sober, then drinking after the crises are over. Making it through the crisis had provided purpose. When the crisis ended, so did the purposeo 
Holmes3 points out that people use alcohol or other substances either to fill the existential void or to avoid it. The only way to eliminate existential void or frustration is through meaning. Therefore, it stands to reason that the way to prevent relapse is to include meaning in recovery. 
PATRICIA E. HAINES, Ph.D., R. N. [121 Merriman Road #B, Akron, Ohio 44303 USA] received her Doctorate in Counseling and Human Development and is a Licensed Professional Clinical Counselor and Certified Chemical Dependency Counselor Ill, a Certified Criminal Justice Specialist, a CertifiedJewish Chaplain, a RegisteredNurse, and a journalist. 
References 
1. 
Crumbaugh, J. C. (1979). Exercises in logoanalysis. In J. Fabry, R. Bulka, & W. Sahakian, (Eds.) Logotherapy in action. NY: Jason Aronson. 

2. 
Frankl. V. E. (1963). Man's search for meaning. NY: Pocket Books. 

3. 
Holmes, R. (1979). Alcoholics. In J. Fabry, R. Bulka, & W. Sahakian (Eds.). Logotherapy in action. NY: Jason Aronson. 

4. 
Lukas, E. (1984). Meaningful living. NY: Grove Press. 


45 
The International Forum for Logotherapy, 199 7, 20, 46-52. 
MEANING LEVELS AND DRUG-ABUSE THERAPY: AN EMPIRICAL STUDY 
Ma. Angeles NOBLEJAS DE LA FLOR 
(ABSTRACT) The meaning levels of the participants of a Spanish drug abuse rehabilitation program were evaluated. There were 125 persons distnbuted into three groups corresponding to different program stages. Thirty-three (33) others who completed the program severai years prior, and 841 from a normal sample, were also considered. PIL and LOGO tests were administered en masse and almost simultaneously in time for the three program groups (transverse design). Statistical analyses suggested that drug addiction is linked to existential frustration and that elimination of the drug addiction problem is related to a significant increase of inner meaning fulfillment, reaching "normal" levels. Some differences between PIL and LOGO tests were found. 
This research evaluated inner meaning fulfillment and existential frustration in a Spanish population for whom an existential vacuum is hypothesized by logotherapy: drugdependent individuals. For logotheory, substance abuse is a phenomenon of the mass neurotic triad: depression, aggression, and addiction. 
Existential frustration is the logotherapeutic concept for explaining drug addiction.2 Drug dependence is a vain attempt to fill the existential vacuum. lnde~d, researcher$ report significant inverse relationships between meaning in life and drug abuse.7 ·8 
Hypotheses 
This study assessed the inner meaning fulfillment of drug addicted persons in order to address the relationship between addiction and existential frustration from two points of view: (a) comparison of a drug 

46 
addict sample with a "normal" sample; and (b) study of inner meaning fulfillment at three stages of a therapeutic educational program for drug addicts, and after completing same. 
We assessed two hypotheses-
Hypothesis 1 : Drug addiction is linked with existential 
frustration--addicted people will show significantly lower 
meaning in life than non-addicted. 
Hypothesis 2: Elimination of drug problems is related to a 
significant improvement in meaning of life, until "normal" values 
are reached. 
Subjects 
The subjects in this research were persons with drug-abuse problems. all participants in a therapeutic educational program in Madrid, Spain. The program, Project Man, is one of the best known and most effective in Spain. The subjects were in groups corresponding to Project Man stages: (a) Reception--40 persons who just arrived to the program; (b) Community--40 people in the middle of the program; and 
(c) lntegration--45 people in the last stage, re-encountering their habitual work and life. Additionally, there was a Follow-up group--33 persons who had graduated at least two years previously. Female percentage was lower than male percentage; but the same is true for the general drug addict population.4 In the Follow-up group, female percentage was higher than in the previous stages; this is in accordance with their lower probability of relapse.5 
Instruments 
We used two logotherapy tests for this research. One was the Purpose-In-Life (PIL) test,1 from a North American environment and wide-spread in investigation. The second was the LOGO test,3 from a European environment and more recent. The PIL test assesses meaning, and the LOGO test assesses existential, frustration. 
Procedure 
The experience can be defined as a transverse study where we assumed that the samples obtained were representative of the Project Man stages. The three en masse administrations in Project Man groups were practically simultaneous. Obtaining the Follow-up sample was more time consuming. We considered as a "normal" sample the 841 subjects used to obtain Spanish norms for both tests.6 
47 
Differences in scores were analyzed by means of the non-parametric Kruskal-Wallis' H test and confirmed with a parametric analysis of variance. Also the H test and x2 tests were used to analyze differences between each pair of groups. The use of non-parametric tests was because Likert scales are only ordinal scales and scores are biased from normal distribution.6 To allow comparisons with previous publications we also present the results of the parametric t-test for some comparisons. 
Results 
The evolution of the PIL test and LOGO test scores is presented in Table 1. There was a clear increase (better meaning) of PIL scores from the beginning of the program to the "Integration" stage. Scores at the end of the program were similar to those of the "normal" population. The Follow-up group continued with increasing scores. LOGO test scores decreased (better meaning) except at the "Community" level. 
The Kruskal-Wallis test demonstrated differences between the program subjects at Reception vs. "normal". The same statistical test showed differences between the three stages of the program as a process. All these statistical tests, confirmed by an analysis of variance, yielded statistically significant differences--thus, change in the program was not random. 
As seen at the bottom-left of Table 2, PIL scores showed significant differences between Reception (or Community) vs. Integration (or "normal"). Differences between Reception vs. Community were not significant; nor were differences between Integration vs. "normal." The Follow-up group did not differ significantly from "normal," but it did from the other program groups. The largest changes for PIL scores were between Community vs. Integration and between this last stage vs. Follow-up. 
As seen at the top-right of Table 2, LOGO test scores yielded significant differences for consecutive pairs of Project Man stages except for the Reception vs. Community comparison. The Follow-up group did not differ sifnificantly from "normal." 
48 
Table 1. CHANGES OF PILAND LOGO TESTS SCORES IN "PROJECT MAN" GROUPS 
R  C  F  N  
PIL  I88.1  92.5  103.7  108.9  104.8  
I~D  116.57  12.80  12.19  12.17  16.09  
LOGO  I~D  118.1 I4.14  19.0 4. 11  16.9 3.82  14.6 5.19  14.2 4.39  

R=Reception; C =Community; I= Integration; F = Follow-up; N = Normal. M = Average; SD= Standard deviation. 
Table 2. DIFFERENCES BETWEEN "NORMAL" POPULATION AND "PROJECT MAN" GROUPS (levels of significance) 
R C I F N LOGO 
test 

.0008 ••• .0000 .••
.3795 .2211 
R
R 
.0011 .. .0000 ...
. 1690 .0867 
.0272 . .0001 ••• .0000 ..•
.2692
C 
C 
.0090 .. .0000··· .0000···
.0936 
.0001 ••• .0002 ... 
.0134. .0000 •••
I 
I 
.0000 ... .0000 ... 
.0145 . .0000 ... 
.0000 ..• .0000 ••• .0332 •
F 
.7707 
F 
.0000 ... .0000 .•. 
.0349 . 
.4056 
.0000 ••• .0000 ...
N 
.2320 .2114 
N 
.0000 .•. .0000 .•. 
.3261 .0744 
PIL R C I F N 
test 
Bold figures = Kruskal-Wallis' H test levels of significance. Italic figures = t-test levels of significance. ·, ··, ••• = Significant differences at 95%, 99% and 99.9% probability. Left bottom sub-array, PIL test; right top sub-array, LOGO test. R = Reception; C = Community; I= Integration; F = Follow-up; N =Normal. 
49 
Discussion 
Shean and Fechtmann8 report an average PIL score of 88.47 in a sample of college students involved in the consumption of soft drugs. This score is similar to that found at the Project Man Reception stage. A comparison with the Padelford7 study is not possible because it does not show PIL scores for a drug addict sample--just a correlation between these PIL scores and a drug involvement index. 
The average age of subjects increased steeply from the Reception to the Follow-up group; which supports interpretation of results as an evolution from similar starting groups even with the tranverse design used. A longitudinal design research (where SONG test is also used as predictor for meaning search), has been started but will be time consuming. 
The results of the present study show clearly a decreased meaning in life for the population with drug problems (represented here by the Reception group) compared to a normal population. An increasing evolution of level of meaning in life through the program is also demonstrated. 
Of interest is the low standard deviations of our test scores relative to other clinical groups (e.g., 19.68 for PIL test6 , 7.37 for LOGO test3). Logotherapy suggests that groups with difficulties in finding meaning (the ill) will show high deviations--this makes possible, in a percentage of cases, the discovery of a good inner meaning fulfillment despite the illness (thus confirming the human ability to find meaning even during severe circumstances). 
Because of the difference found in the test scores between Integration and Follow-up groups, an area for further investigation is the capability of graduated subjects to increasingly improve their purpose in life in the real world. Perhaps the tests will provide "normal" scores when a 20% relapse has been eliminated. In our Follow-up group there were no people who relapsed, but there is usually a 20% relapse in Project Man graduates. 
50 
Conclusions 
Given the significant differences in both PIL and LOGO test scores between the Project Man Reception group and normative samples, we can state that drug addiction is linked to a situation of existential frustration. This confirms our first hypothesis. 
For our second hypothesis, we can assert that the elimination of a drug addiction problem is related with a significant increase of inner meaning fulfillment, reaching "normal" levels. This has been demonstrated by significant differences between Project Man groups, and especially by differences between our Reception group (representative of the drug dependent population) and the Follow-up group (representative of the population for whom drug problems have been eradicated). 
In regard to the study of Madrid's Project Man stages (Reception, Community, Integration) we can conclude that PIL test scores show significant differences between initial (Reception) vs. final (Integration) Project Man stages. An increasing meaning in life causes the Integration group to not be significantly different from a "normal" sample. Similarly, LOGO test scores show a non-significant change in meaning of life by the Community stage, followed by a significant improvement at the Integration stage. 
Following completion of the Project Man program, a gradual increase in meaning persists until "normal" meaning levels for the Follow-up group are achieved. These results can not be conclusively attributed to only the therapeutic intervention because we have no control over all the intervening variables. 
M. ANGELES NOBLEJAS DE LA FLOR, Ph.D. [C/ Chantada 2, 1-1; 28029 Madrid; Spain] is an Educational Psychologist at the Ministry of Education in Spain, Dip/ornate ofthe Italian Logo therapeutic Association, and a founding member of the Spanish Association for Logotherapy. 
51 
References 
1. 
Crumbaugh, J. C., & Maholick, L. T. (1969). Manual of instructions for the Purpose in Life test. Saratoga, CA: Viktor Frankl Institute of Logotherapy. 

2. 
Lukas, E. (1983). Tu vida tiene sentido. Logoterapia y salud mental. Madrid: S. M. (original from 1980). 

3. 
Lukas, E. (1986). LOGO-test. Test zur messung van 'innerer sinnerftJl/ung' und 'existentieller frustration'. Wien: Deuticke. (Spanish translation by J. Coloma). 

4. 
Martinez Diaz, M. P. (1994). El proceso de individuaci6n en la familia de origen durant~ la adolescencia. Una aplicaci6n a personas con problemas de toxicomania. Doctoral Thesis. Universidad Pontificia de Comillas, Facultad de Filosoffa y Letras, Secci6n Psicologfa, Madrid. 

5. 
Munoz Fernandez, M. (1994). £studio sabre altas terapeuticas. Madrid: Centro Espanol de Solidaridad "Proyecto Hombre". 

6. 
Noblejas de la Flor, M. A. (1994). Logoterapia. Fundamentos, principios y aplicaci6n. Una experiencia de evaluaci6n def "logro interior de sentido ". Doctoral Thesis. Universidad Complutense, Facultad de Educaci6n, Madrid. 

7. 
Padelford, B. L. (1974). Relationship between drug involvement and purpose in life. Journal of Clinical Psychology, 30, 303-305. 

8. 
Shean, G.D., & Fechtmann, F. (1971). Purpose in life scores of student marijuana users. Journal of Clinical Psychology, 26, 112113. 


52 
The International Forum for Logotherapy, 199 7, 20, 53. 
Logotherapeutic Aphorisms by Elisabeth Lukas 
There are mistakes parents cannot repair, but there are no parental mistakes children cannot make peace with. 
In a healthy family every member has a meaningful function. Freedom does not mean doing what you want, but wanting what is to be done. 
Achievement is to be judged by the given abilities. Denial is no solution. Not being able to enjoy the small pleasures is to deny yourself the joys 
of life. 
Our time does not lack psychological conflicts but the capacity to bear them. Feelings of meaninglessness and neighborly love exclude each other. A meaningful life in poverty is a more fertile soil for inner satisfaction 
than a meaningless life in useless wealth. The meaning of chance is our attitude to it. Truth is never unequivocal; not in religion, not in physics, not in 
psychology. 
Modern men and women have modern illusions, and one of them is the idea that they are able to correct everything. True heroes in life are not the victors who celebrate their victories but 
the defeated who in their suffering still can detect glimpses of hope. 
53 
ISSN 0190-3379 IFODL 20(1)1-64(1997) 
The International Forum for 
LOGOTHERAPY 
Journal of Search for Meaning