Meaning-Centred Therapy

A Brief Manual for Meaning-Centered Counseling

Paul Wong
Paul Wong, Ph.D, C.Psych

Preface

This manual grows out of MCC workshops I have given in the last ten years to psychologists, counselors, coaches, and other mental health professionals all over the world. The feedback I have received from attendees and alumni of these workshops confirm that MCC’s focus on positive motivation and the transformation through meaning has been very helpful for those devastated by the tsunami of life.

The responses from counsellors, occupational therapists, social workers, and nurses working in geriatric care, rehabilitation and hospice-palliative care, and addiction fields have been particularly gratifying – they find the positive message of MCC uplifting and the practical MCC skills efficacious even for terminally ill and chronically handicapped patients.

What makes MCC a potent form of positive therapy is its stance that there are no hopeless cases; there is always hope for positive change. Healing and recovery can be a long and daunting uphill battle. MCC provides both the motivation and the roadmap for positive transformation.

Based on the concept of tragic optimism in logotherapy (Frankl, 1984; Wong, 2007), MCC maintains that meaning and hope can be found regardless of circumstances up the last breath. Born out of desperation and nurtured by adversity, tragic optimism is the kind of hope that can weather the worst storms and disasters.

What makes MCC efficacious is that it is integrative with meaning as its core construct. MCC integrates logotherapy, humanistic-existential psychotherapy with cognitive-behavioral and narrative therapies. It also incorporates cultural, spiritual issues and findings from positive psychology, because meaning is individually construed but socially and culturally constructed.

MCC capitalizes on the uniquely human capacity to discover and create meanings out of the raw and often painful life experiences. This model is inherently rather than technically integrative, because meaning systems necessarily involve cognitive, behavioral, motivational, affective, narrative, and cultural components.

MCC is also intrinsically positive, because of its affirmation of the defiant human spirit to survive and flourish. MCC maintains that individuals have almost unlimited capacity to construct complex meaning systems that both protect them from the inevitable negative life experiences and empower them to make life worth living during very difficult times.

In sum, MCC equips clinicians with the fundamental principles and skills to (a) motivate and empower clients in their struggle for survival and fulfillment, (b) to tap into people’s capacity for meaning construction in order to help clients restore purpose, faith and hope in their predicaments, (c) to provide the necessary tools for clients to overcome their difficulties and fulfill their life’s mission.

Most sections of this manual have been presented in MCC workshops elsewhere. In response to the numerous demands for further information on MCC, this manual represents my attempt to put together previous workshop materials with considerably new information. In addition to provide guidelines for the practice of MCC, this manual can also be used as an outline for teaching MCC to undergraduate and graduate students.

Most of the materials in this manual are presented in bullet-form based on previous power-point presentations. Those interested in learning MCC in greater depth and detail, please contact pwong@tyndale.ca about training courses offered by the Meaning-Centered Counseling Institute, Inc.

The next Workshop on Meaning-Centered Counselling and Narrative Therapy will be offered during the 5th International Meaning Conference to be held in Toronto, July 24-26, 2008. Those interested in attending the pre-conference workshop or the full conference may access www.meaning.ca for more information or contact me at pwong@tyndale.ca.

CHAPTER ONE: INTRODUCTION

The new millennium began ominously with 9/11. Since then, it has witnessed a string of geopolitical wars, natural disasters, terrorist bombings, and human tragedies. The recent events of campus rampage (i.e., Virginia Tech and North Illinois University) further reveals that there remains a strong undercurrent of anger, frustration, despair and existential angst, which manifests itself in an increase in mental disorders and violent outbursts.

There are untold millions of Home Patiens — the suffering human beings. In spite of the recent happiness craze sweeping across world, so many are still drowning in an ocean of suffering. Life is hard for most people: Some feel defeated by life and have resigned to quite desperation. Others feel exhausted and discouraged in their endless struggle. Still others mourn the loss their loved ones through terminal illness, death or other misfortunes. The cacophony of their screams of pain and cries for help makes happy tunes sound foreign and discordant.

The state of the union is not good in terms of human scales. The events of the last few years have made it particularly clear that technological advancement, economic prosperity and even career success will not bring happiness and the good life, unless progress is made in the area of humanistic and spiritual values.

Against this dark backdrop, MCC offers a bright vision for humanity. It is a meaning-centered and spiritually oriented positive psychology; it is a motivational counseling that affirms that one can find hope, meaning and happiness, regardless of how bleak the reality. It is a positive therapy or positive applied psychology that revolves around the central issue of what makes life worth living. The empirical research in positive psychology provides much of the foundation for MCC (Wong, in press; Wong and Fry, 1998).

MCC favors a psycho-education approach that equips clients with conceptual tools and practical skills that can be used to make life better. It emphasizes the importance of applying the principles and strategies of MCC to daily living; efficacious therapy needs to have broad and practical applications in all arenas of life!

Rooted in the basic tenets of Viktor Frankl’s logotherapy, MCC extends classical logotherapy (Wong 1997, 2002, 2005a, 2007) and integrates it with various schools of psychotherapy, such as existential-humanistic psychology, cognitive-behavioral therapy, and narrative therapy (Wong, 1998c, 2005b). A brief survey of Frankl’s logotherapy is presented in the next chapter.

Since meaning is both individually and socially constructed, MCC is multicultural in its fundamental orientation. It embraces wisdom traditions from East and West and shows cultural sensitivity in working with clients from different racial, ethnic and cultural backgrounds, because of their different perspectives and experiences with stress (Wong & Wong, 2006).

Macro counseling skills

Another defining characteristic of MCC it that it addresses both micro and macro issues. MCC is concerned with both individual’s presenting problems and the larger context in which these problems are situated.

Macro counselling skills help clients to view their predicaments in the larger schemes of things, thus, broadening and deepening their understanding of the meaning of their problems and their potential for positive change. Macro skills are needed to address the following issues:

  1. The negative aspects of the human conditions: As physical creatures, they are vulnerable to pain, illness, injury, aging, and death concerns. As emotional beings, they are susceptible to anxiety, depression anger, and mood swing. These universal human experiences help normalize clients’ problems.
  2. The positive aspects of the human conditions: By tapping into the universal human tendency to pursue meaning, happiness and growth, we can revive clients’ motivation for self-preservation and positive change.
  3. The social-economic-political-cultural forces: By recognizing these macro forces can shape and constrain individual values and behaviors, we can minimize clients’ tendency of self-blame and at the same time awaken their awareness of the larger struggle for social justice and human rights.
  4. The meta-narratives of religions, myths and legends. By relating their personal problems to an appropriate and preferred over-arching story, they become aware of transcendental sources of wisdom and inspiration that can be uplifting and life-changing.

Another unique feature of MCC is its intervention strategy of double-vision. This two-pronged strategy aims at addressing both the presenting problems and the larger existential concerns and longer life-goals. Double vision is an important macro skill for several reasons:

  1. If we focus on a tree, we may lose sight of the forest. We can gain a deeper insight into our clients’ predicaments by looking at the big picture.
  2. If we can help restore clients’ passion and purpose for living, this will reinforce their motivation for change.
  3. By looking beyond the pressing, immediate concerns, MCC seeks to awaken clients’ sense of responsibility to something larger than themselves.

This manual describes micro intervention skills to facilitate problem-solving as well as the personal quest for meaning in the throe of suffering. It will explain how the intervention strategy of ABCDE works. (A stands for Acceptance, B for Belief and affirmation, C for Commitment to specific goals or projects, D for Discovering meaning and significance, and E for Enjoyment of the discovery or Evaluation of whether the preceding steps have achieved the desired positive outcomes.)

The centrality of meaning

MCC recognizes that a formless void engulfs the human existence. All behaviors, in one way or another, are aimed at filling this vacuum. Unfortunately most of the human endeavors have failed because of our preoccupation with a quick fix of this existential problem and our obsession with happiness as a distraction. MCC advocates a less traveled road — the primacy of purpose and responsibility for living and dying well.

We need to do the right thing and do the hard work in order to live a responsible and meaningful life, but such pursuit of meaning calls for self-sacrifice and suffering. Consistent with most faith traditions and the tenets of logotherapy, MCC believes that the terminal value of self-centered pursuits of personal happiness and success often lead to disillusion and misery, while ultimate concern of living a responsible and meaningful life lead to fulfillment. Authentic happiness is a by-product of self-less surrender and commitment to a higher purpose.

This manual introduces readers to the meaning-management theory (MMT) as the conceptual framework for both meaning-centered macro and micro skills. MMT is a dual-system model, which emphasizes the need to incorporate both approach and avoidance systems as the most effective way to protect individuals against negative aspects of human existence and at the same time empower their quest for meaning and fulfillment.

MCC emphasizes that meaning is all we need and relationship is all we have in the therapeutic situation. Each counseling session constitutes a genuine existential encounter. In this here-and-now encounter, where life flows back and forth between two human beings, the messenger is more important than the message, and the therapist more important than the therapy.

In other words, an effective counselling process involves much more than mere exchange of words; it also entails the non-verbal interactions between two unique personalities and lives. Thus, in addition to clinical competence, a MCC practitioner needs to be a securely centered person, who possesses the Rogerian characteristics of genuineness, empathy and unconditional positive regard.

CHAPTER TWO: A BRIEF REVIEW OF LOGOTHERAPY

Logotherapy literally means therapy through meaning. It may be translated as meaning-oriented or meaning-centered therapy. Existential analysis is the therapeutic process to remove all the unconscious blocks and awaken the human spirit to live responsibly and meaningfully.

Year 2005 marked the 100th birthday of Viktor Frankl, who continues to impact the world largely through his autobiographical book “Man’s Search for Meaning”, which remains of the all time best sellers.

His influence on psychology and psychotherapy is well documented in Batthyany and Guttmann (2006) and Batthyany and Levinson (2008). His impact on positive psychology has been highlighted by Wong (2008, in press).

Logotherapy and spirituality

Unlike Freud’s psychoanalysis and Alder’s individual psychology, Frankl considers logotherapy as a spiritually-oriented approach towards psychotherapy. “A psychotherapy which 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’” (Frankl, 1986, xvii).

Existential analysis is needed to make the clients aware of their spirituality and capacity for meaning. “Inasmuch as logotherapy makes him aware of the hidden logos of his existence, it is an analytical process” (Frankl, 1984, p.125). However, in Dr. Frankl’s writing, the two terms are used either interchangeably or together as a compound term.

Logotherapy incorporates spirituality; it emphasizes the need to relate and respond to the Ultimate Meaning, and makes clients confront the Logos within them. It focuses on the human responsibility to live meaningfully and purposefully in every situation and every day in order to become what they are meant to be. It is truly positive therapy because it is capable of providing comfort and hope in the most tragic situations.

According to Frankl, three factors characterize human existence: spirituality, freedom, and responsibility. The spiritual dimension is the very core of our humanness, the essence of humanity. The defiant power of the human spirit refers to the human capacity to tap into the spiritual dimension in order to transcend the detrimental effects of stressful situations, illness or the influence of the past.

One of the propositions of logotherapy is that the human spirit is our healthy core, which does not get sick, even when the psychobiological organism is injured. The human spirit may be blocked by biological or psychological sickness, but it will remain intact; the spirit does not get sick, even when the psychobiological organism is injured. Although the focus is always on the quest for existential meaning, the main objective of existential analysis is to remove the blocks and free the human spirit to fulfill its tasks.

The human spirit is the most important resource in psychotherapy. According to Fabry (1994, p.18), the noetic dimension or the human spirit, is the “medicine chest” of logotherapy, which contains various inner resources, such as love, the will to meaning, purpose in life, creativity, conscience, the capacity for choice, sense of humour, commitment to tasks, ideals, imagination, responsibility, compassion, forgiveness. Therefore, existential analysis focuses on activating the noetic dimension through a variety of therapeutic means, such as the appealing technique, modification of attitude, Socratic dialogue, paradoxical intention, and dereflection.

When existential analysis is effective, the clients will become more open and more accepting of themselves. They will also feel free to engage the world in a responsible and courageous manner. As a result, they are able to lead an authentic and meaningful life.
Both logotherapy and MCC attempt to awaken people’s awareness of the importance of spirituality, freedom and responsibility in recovery and personal growth. Happiness is a by-product of the discovery of meaning.

The meaning of life

What is the meaning of life? This remains one of the most commonly asked questions. Philosophers have wrestled with this perplexing question for thousands of years. Psychologists have also researched this issue. The recent positive psychology movement considers the question of what makes life worth living one of the most important research issues.

How do we answer the existential question: “Is life as a whole meaningful or meaningless”? On the one hand, he avoids giving an abstract answer to such a general existential question; on the other hand, he affirms the potential of finding meaning in all situations as life unfolds. Thus, a life is worth living if one can erect an endless series of monuments of meaningful moments.

However, every meaning is unique to each person, and each one has to discover the meaning of each particular situation for oneself. The therapist can only challenge and guide the client to potential areas of meaning.

Frankl believes that “by virtue of the fact that meaning may be ‘squeezed out’ even from suffering, life proves to be potentially meaningful literally up to its last moment, up to one’s last breath.” He (1984) prescribes three ways of finding meaning: creative, experiential, and attitudinal values:

According to logotherapy, we can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take towards unavoidable suffering” (p. 133).

Attitudinal values are especially important in situations of unavoidable suffering. When every freedom is taken away from us, we still have the freedom to choose our attitude to respond to our fate.

“This is why life never ceases to hold meaning, for even a person who is deprived of both creative and experiential values is still challenged by a meaning to fulfill, that is, by the meaning inherent in the right, in an upright way of suffering” ( Frankl, 1969, p. 70).

Frankl emphasizes that there is “demand quality of life” in every situation and in each one’s life. We are called to respond to what life demands of us in order to live with authenticity and fulfill our destiny. We do not ask what we can get from life, but what life demands of us.

Frankl (1963) also emphasizes that meaning is discovered rather than created: “The meaning of our existence is not invented by ourselves, but rather detected” (p. 157). This is intended to convey the message that one cannot create meaning simply by arbitrarily pursing some misguided ambition as in the case of Hitler; however, one can discover the meaningfulness of one’s action and response in light of some enduring and transcendental human values.

He focuses on the unique meaning of each concrete situation and our responsible reaction to it. “What matters, therefore, is not the meaning of life in general, but rather the specific meaning of a person’s life at a given moment” (p. 171).
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Viktor Frankl must be credited as the first psychotherapist who takes an unequivocally affirmative position on this issue. He maintains that there is ultimate meaning and purpose in human existence and that one can discover positive meanings even in the worst, unimaginable situations. This affirmation of meaning is the cornerstone of logotherapy.

Existential frustration and noogenic neurosis

Existential frustration is a universal human experience, because the quest for existential meaning can be blocked by external circumstances as well as internal hindrances. When the will to meaning is frustrated, one may develop noogenic neurosis or existential vacuum. “Noogenic neuroses have their origin not in the psychological but rather in the ‘noological’ (from the Greek noos meaning mind) dimension of human existence” (Frankl, 1984, p.123). Logotherapy is specifically appropriate in dealing with existential neuroses.

Existential vacuum refers to general sense of meaninglessness or emptiness, as evidenced by a state of boredom. It is a widespread phenomenon of the twentieth century, as a result of industrialization, the loss of traditional values, and dehumanization of individuals. Most people may experience existential vacuum without developing existential neurosis. Many people feel that life has no purpose, no challenge, no obligation and they try to fill their existential vacuum with material things, pleasure, sex, power, busy work, but they are misguided (Frankl, 1984). According to Frankl (1986), feelings of meaninglessness underlie “the mass neurotic triad of today, i.e., depression-addiction-aggression” (p. 298).

Existential vacuum is not a neurosis or disease. In fact, it may make us aware of our own emptiness and trigger a quest for meaning. The therapist can empower and challenge the clients to fill their inner emptiness. Logotherapy can supplement psychotherapy in psychogenic cases and somatogenic neurosis, because “by filling the existential vacuum, the patient will be prevented from suffering further relapses” (Frankl, 1984, p.130)

The meaning of death

The terror of death figures prominently in existential psychology. Like a menacing dark cloud, death is always on the horizon, threatening to rob us of our most cherished happiness and hope. The undeniable fact remains that all we have ever aspired and all we have achieved can be nullified by a single stroke of death; this prospect of becoming nothingness makes us question the meaning of human existence.

Frankl argues that death does not automatically render life meaningless, and proposes that the meaning of death is predicated on the meaning of life. He then emphasizes the uniqueness of every human being and the imperative of using our freedom to fulfill our unique destiny.

To live and die meaningfully, we need to value each moment in every situation. “The moment becomes eternity if the possibilities hidden in the present are converted into those realities which are held safely in the past for all eternity. That is the meaning of all actualizing” (Frankl)

Therefore, those who live well will die well. Those who live a responsible and meaningful life will be able to die with satisfaction and hope, knowing that their spirit will live on not only through the monuments they have sculptured, but also thorough the transcendental and eternal spirit.

The meaning of suffering

Buddhist first noble truth is that life is suffering. It is not possible for any human being to go through life without ever experiencing pain, heartbreak, sorrow, weariness, agony, despair, sickness and afflictions and finally death. No one likes suffering. It is only normal that we regard suffering as bad, evil, and an unwelcome intrusion into our lives.

Viktor Frankl confronts the reality of suffering with profound courage and insight: “Suffering and trouble belong to life as much as fate and death. None of these can be subtracted from life without destroying its meaning.” Furthermore, he (1984) reasons that: “If there is a meaning in life at all, then there must be a meaning in suffering. Suffering is an ineradicable part of life, even as fate and death” (p. 88)

Suffering is not a necessary condition for meaning, but suffering tends to trigger the quest for meaning. Frankl (1967) observes that the Homo Sapiens is concerned with success, while the Home Patiens (the suffering human being) is more concerned about meaning.

Frankl (1963, 1984, 1986) has observed through his own experience and his observation of prisoners and clients that people are willing to endure any suffering, if they are convinced that this suffering has meaning. Suffering without meaning will lead to despair.

Logotherapists do not ask for the reason for suffering, but guide their clients towards the realization of concrete meanings, and choose the right attitudes. Often, logotherapists appeal to their clients to take a heroic stand towards suffering, by suggesting that unavoidable suffering gives them the opportunity to bear witness to the human potential and dignity. Frank (1986):

Whenever one is confronted with an inescapable, unavoidable situation, whenever one has to face a fate that cannot be changed, e.g., an incurable disease, just then is one given a last chance to actualize the highest value, to fulfill the deepest meaning, the true meaning of suffering” (p. 178).

Search for meaning is more likely to be occasioned by three negative facets of human existence: pain, guilt, and death. Pain refers to human suffering, guilt to the awareness of our fallibility, and death to our awareness of the transitoriness of life (Frankl, 1967, 1984). These negative experiences make us more aware of our needs for meaning and spiritual aspiration. Neuroses are more likely to originate from our attempt to obscure the reality of pain, guilt, and death as existential facts (Frankl, 1967, 1984).

Logotherapy provides an answer to the tragic triad through attitudinal values and tragic optimism (Frankl, 1984):

I speak of a tragic optimism, that is, an optimism in the face of tragedy and in view of the human potential which at its best always allows for: (1) turning suffering in to a human achievement and accomplishment; (2) deriving from guilt the opportunity to change oneself for the better; and (3) deriving from life’s transitoriness an incentive to take responsible action” (p. 162).

One of the main purposes of logotherapy and MCC is twofold: (a) To make suffering more bearable thorough the discovery and reconstruction of meaning, and (b) To awaken the defiant human spirit of accepting and enduring suffering. This positive “attitude value” in the face of suffering and death is possible, only when we fully grasp the essence of meaning and responsibility.

However undesirable suffering can yield some benefits. It purifies and elevates our lives. It awakens us to the need of repentance and amendments. Like surgery, psychological suffering is often a necessary experience before we give up self-destructive habits. It teaches us what we ought not to be and what we ought to be. It enables us to develop moral fortitude and the capacity of perseverance. It clarifies for us what really matters most in life.

The Meaning of Work

Most people would agree that meaningful work is more important that a good paying job devoid of intrinsic meaning and significance. But what does it mean to find meaningful employment? Does it depend on the status of the profession? Does the work need to be intrinsically interesting?

Since we spend most of our adult life working for a living, it stands to reason the meaning of our life to a large extent hinges on the meaning of our work. Underemployment, unemployment and toxic employment can severely undermine life satisfaction. Making a wrong career choice can also derail us in our quest for meaning and happiness.

Frankl debunking various myths about the meaning of work and points out the work itself does not create meaning – it only gives individuals the opportunities to do so. The main thing is that what people bring to work is more important that the work itself.

He then identifies the sources of meaning at work. These include meeting the higher human needs, expressing one’s uniqueness, opportunities for creative and experiential values, and fulfilling one’s life goals and missions.

The meaning of love

Love is perhaps one of the most powerful human motivations. It can fill our lives with happiness and meaning and uplift the welfare of humanity. However, when it is frustrated or misguided, it can be a very destructive force for individuals and society.

Most people yearn for true love and realize that it is based on a meaningful relationship rather than sexual attraction. But what is a meaningful relationship? What is the meaning of true love?

To Frankl, love is the precious gift that makes everything beautiful. He defines true love as an enduring, unique, and exclusive intimate relationship that provides opportunities for fulfilling the experiential values of meaning. Ideally, true love is its own warranty of permanence and guarantee of fidelity, because the spiritual core does not change. Once we experience true love, we will abide with this truth for ever. True love necessarily enriches both the lover and the beloved. Thus, life is impoverished, when it is devoid of love.

In contrast, unrequited love is primarily an emotional response based on sexual attraction and infatuation. Often, the object of infatuation is idealized to the extent that it bears little or no resemblance to the real person, because unrequited love is hopeless and desperate love with a phantom of one’s own creation to meet one’s frustrated need for intimacy. When love is not reciprocated, it results in pain and pathological jealousy. Frankl’s insight can help people avoid and overcome the vicious cycle of love addiction.

In spite of Frankl’s lofty ideals about true love, divorce does happen and now happens with increasing frequency. Logotherapy and MCC provide helpful guidelines to maintain enduring meaningful relationships through a deeper understanding each other’s values and meaning-systems.

Neurosis and logotherapeutic techniques

The term neurosis has been replaced by mental or personality disorders in APA’s Diagnostic Statistics Manual. However, Frankl’s classification and treatment of neurosis are still helpful to counsellors and psychologists.

Frankl recognizes that only certain types of neuroses (e.g., existentially based mental disorders) are most amendable to logotherapy and existential analysis. Logotherapy focuses on the discovery of responsibility and existential meaning. General existential analysis addresses the human concerns about the meaning of life and the meaning of death. Special existential analysis addresses the existential needs underlying neurosis, depression and psychosis.

The three most commonly used logotherapeutic techniques are paradoxical intention, de-reflection and Socratic questioning. This lecture will explain and illustrate how these clinical skills can be effectively applied to treat individual neuroses.

The human capacity for self-distancing is essential for logotherapy, because it enables the clients to separate themselves from the problem; this is similar to Michael White’s (2007) concept of externalization in narrative therapy. The next step is to awaken the defiant human spirit and empower clients to believe that they can overcome the problem or symptom which is not an integral part of personhood.

Paradoxical intention (PI) is based on the capacity of self-distance – they are not their fears. PI is paradoxical, because the clients are encouraged to intend or wish what they fear most. Anticipatory anxiety can be greatly reduced through direct confrontation with fear itself.

Dereflection is based on the capacity for self-transcendence and the will to meaning. Through dereflection, the clients learn to refocus to something or someone beyond their current concerns and become immersed in something creative and meaningful.

Socratic dialogue serves the general purpose of drawing out from the clients what they already know intuitively. The assumption is that deep inside our spiritual core, we know what is meaningful and what we are meant to be. Socratic questions facilitate the discovery that they have the freedom and responsibility to life’s demands.

Depression and psychoses

Frankl recognizes that in endogenous mental illnesses (such as clinical major depression, bipolar disorders and schizophrenia), Logotherapy can be effective in treating the psychogenetic and existential aspects of endogenous psychoses, especially in terms of helping patients to address existential anxiety and develop a positive attitude towards the constitutional or incurable mental illnesses.

Central to both logotherapy and MCC is the importance of acceptance. The patients need to accept the fact that they are sick and they need help. They also need to accept their endogenous illness in order to counteract their tendency towards self-blame.

Another important component is belief or trust. We need to help patients believe that they can discover new sight that will bestow new meaning on their condition. They need to believe that some progress is attainable if they are committed to the regimen of medication. They need to be patient and keep faith, which will facilitate recovery and healing.

With regard to moderate cases of psychoses, existential analysis can help patients externalize their illness and see themselves as the real persons apart from their illness. We also need to help them understand that they have a spiritual core which cannot be injured by psychoses. It is important to awaken their defiant human spirit and maintain that the life of a psychotic patient is still worth living – he or she can still maintain the dignity of a suffering person (Homo patiens).

Assessment of logotherapy

Logotherapy is unique in that it emphasizes the spiritual dimension of human existence as the source of meaning, hope, dignity, uniqueness, and freedom. The importance of spirituality in healing has gained widespread acceptance in today’s therapeutic community, but Frankl was the first one to make spirituality the cornerstone of his approach to psychotherapy.

Frankl can also be credited as the father of positive existential psychology and positive psychotherapy (Wong, 2007). Rather than focusing on what is wrong with us, Frankl focuses on what is right with us and what is good about life, in spite of the horrors he has endured. He emphasizes our capacity to respond to our meaning-potentials: through our affirmative and optimistic responses to events, we can transcend negative forces and live meaningful lives whatever our circumstances.

Logotherapy emphasizes the importance of attitude towards human existence, because our worldviews and life-orientation may have far more influence on how we live our lives than our cognitions and behaviours in specific situations. Because of its general holistic orientation, logotherapy can be applied to a wide variety of disciplines, ranging from medicine, counselling, pastoral care, education, and management. It can also be employed in all areas of our lives so that we can fulfill our potentials.

Logotherapy is essentially an effective form of motivational counselling. Its emphasis on the quest for meaning as a primary motive provides the common ground for a conversation on reasons for living. Its appeal to the defiant human spirit provides the impetus for people to endure the pain and overcome obstacles. Its focus on human responsibility can effectively reorient clients from self-centered pursuit to something larger than themselves. When all is lost, when one is at the end of the rope, logotherapy opens up new vistas of hope and empowers clients to move forward.

However, there are three limitations. Firstly, logotherapy is often referred to by logotherapists as the Franklian philosophy. It is indeed a philosophy of life, and a very powerful one. As an existential-phenomenological philosophy, it is difficult to be subjected to empirical test, although the general ideas of logotherapy about the vital role of meaning and purpose continue to inspire empirical studies (Wong & Fry, 1998; Wong, 2006).

Secondly, Viktor Frankl intended logotherapy as an adjunct to whatever therapy one practices. It offers several logotherapeutic techniques to treat existential neurosis, but it does not provide a comprehensive system of counselling or psychotherapy.

Thirdly, many Frankl “loyalists” are opposed to any extension of logotherapy. They are more “catholic then the Pope” in their rigid and dogmatic approach to logotherapy. Their entrenched legalistic attitude has actually done more harm than good in terms of advancing Frankl’s ideals around the globe. In fact, Viktor Frankl has always intended logotherapy for the betterment of humanity, rather than a “clinical specialty” for the career benefits of a few psychotherapists.

In the true spirit of Viktor Frankl, Joseph Fabry was also progressive and forward looking (Wong, 1999). He was largely responsible for introducing logotherapy to North America, and the founder of Viktor Frankl Institute of Logotherapy and founding editor of the International Forum of Logotherapy. It was thorough his unfailing support and encouragement that I was able to develop the integrative meaning-centered counselling (MCC) (Wong, 1999a, 1999b).