This past August, INPM hosted a virtual conference on suffering and flourishing during the pandemic. It was an eye-opening experience because it was our first virtual conference. It also served as a reminder that life requires that we adapt to new realities. The losses and deaths of the pandemic also served as a reminder that human suffering is part of life. I take some comfort in knowing that INPM and other groups are highlighting important research on human suffering and, in the process, providing an important service to people who struggle with mental health issues.
Many people calling my family’s residential mental health program—Sunshine Coast Health Centre (SCHC)—have reported feeling more lonely, anxious, and hopeless during the pandemic. Our meaning-centred approach is designed, in part, to help them make sense of these feelings. In this article I share how SCHC is applying meaning in a multidisciplinary treatment setting, working with clients with moderate to severe mental health and addiction issues.
SCHC’s Meaning-Centred Treatment Philosophy
SCHC’s treatment philosophy is based upon the work of Viktor Frankl, Paul Wong, and others. We talk a lot about “being the author of your life” and other existential-humanistic concepts. Consistent with the existential-humanistic writings of Rollo May and Irvin Yalom, we do not treat mental health issues as pathologies. Meaning has worked well as an umbrella theory, allowing us to integrate numerous evidence-based therapies, such as cognitive-behavioral and narrative therapies. Unlike Frankl’s logotherapy, however, meaning therapy is a standalone therapy that we use to treat multiple mental health issues, including substance use disorder, trauma, depression, and anxiety.
At the same time, we have long recognized the need to be systematic in bringing meaning into our program. This past year, management decided that it is time to design and implement treatment planning that is based on meaning. That has meant building upon our meaning-centered treatment philosophy and staffing the program with people who share our vision of treating the whole person.
Of course, we have to “operationalize meaning,” as our program director Dr. Geoff Thompson describes it, which means taking meaning as a theoretical concept and creating a therapeutic program we can deliver and measure in terms of treatment goals. Such goals require that we factor in a number of goal-planning considerations, such as evidence-based support, client input, ability of staff to support clients in meeting their goals, and so on.
The ‘Big Four’: Our First Attempt at a Meaning-Centred Treatment Planning Model
After much work among managers, clinical staff members, and nurses, we arrived at a ‘Big Four’ treatment planning model. The Big Four represents four processes that serve to organize treatment planning goals: self-definition, relatedness, motivation, and stabilization. A brief examination of each of these processes follows.
Self-Definition and Relatedness
We have focused on self-definition and relatedness as key constructs for living a meaningful life. This approach has broad agreement among psychologists. For example, psychologist Sidney J. Blatt proposes self-definition and relatedness as psychological processes central to the maintenance of therapeutic change (Luyten & Blatt, 2011). Blatt’s two-polarities model emphasizes the interdependent nature of self-definition and relatedness. According to Blatt, a child who develops these processes in relative balance develops a sense of self and self-sufficiency that, in turn, leads to satisfying and nurturing relationships. Self-definition and relatedness are also consistent with McAdams’ (1997) two basic, therapeutic questions: “Who am I?” (ie, agency) and “How do I fit into the world around me?” (ie, community).
Paul Wong posits motivation as one of four essential components of meaning (see Purpose in Wong’s PURE model; Wong, 2010). We are particularly interested in helping clients develop intrinsic motivation, based on their core values, interests, and a personal sense of morality. Granted, our expectation that clients will develop intrinsic motivation is modest, given that a typical client stay at our facility is only 42 days. Newly-admitted clients tend to focus almost exclusively on external factors, looking outside of themselves to make sense of their suffering. Over the course of six weeks, however, we find that many of our clients do gradually reorient and start looking at themselves as the source of their thoughts and feelings. This shift toward intrinsic motivation is central to our meaning-centred treatment planning model.
Stabilization is important in a residential facility, such as ours. Stabilization needs vary from client to client. For example, some clients require medical stabilization, such as support while withdrawing from drugs or alcohol. Others require psychiatric stabilization, aided by medications for treating attention deficit and hyperactivity disorder, depression, and anxiety. Most, if not all, of our clients require stabilization in terms of being able to regulate their emotions (emotion self-regulation). Finally, there are various long-term stabilization needs, such as employment and housing. Working with a multidisciplinary team makes such stabilization support possible.
Our treatment-planning model is, of course, far more complex that this article allows me to describe. We have to report to referral agents and clinical professionals steeped in treatment-as-usual practices, who are unfamiliar with the construct of personal meaning. The templates they demand we use are pathology-based and have little in common with our approach. So the task is complicated. While recognizing that we are in the early stages of developing a meaning-centred model of treatment planning, we are nonetheless excited to see what meaningful change awaits in 2022!
Available upon request.