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Logotherapy for clinical practice

December 2008
Psychotherapy Theory Research Practice Training 45(4):447-63

DOI:10.1037/a0014331

Source
PubMed

Authors:

Stefan E Schulenberg

University of Mississippi

Carrie Nassif

Carrie Nassif Phd

Julius Rogina

Logotherapy is based on the meaning-focused existential philosophy of Viktor E. Frankl (1905-1997). Numerous mental health professionals have been inspired by his most popular book, Man's Search for Meaning; however, many are unfamiliar with the depth of Frankl's work. The purpose of this article is to discuss the tenets of logotherapy, including fundamental concepts, applicability and techniques, roles of the therapist, and assessment tools and new research findings. Logotherapy can readily be integrated with techniques that mental health professionals frequently use, and thus it has much to offer mental health professionals regardless of their theoretical orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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LOGOTHERAPY FOR CLINICAL PRACTICE

STEFAN E. SCHULENBERG

University of Mississippi, Oxford

ROBERT R. HUTZELL

Knoxville, Iowa

CARRIE NASSIF

Fort Hays State University

JULIUS M. ROGINA

Diocese of Nevada

Logotherapy is based on the meaning-

focused existential philosophy of Viktor

E. Frankl (1905–1997). Numerous men-

tal health professionals have been in-

spired by his most popular book, Man’s

Search for Meaning; however, many

are unfamiliar with the depth of

Frankl’s work. The purpose of this arti-

cle is to discuss the tenets of logoth-

erapy, including fundamental concepts,

applicability and techniques, roles of

the therapist, and assessment tools and

new research ﬁndings. Logotherapy can

readily be integrated with techniques

that mental health professionals fre-

quently use, and thus it has much to

offer mental health professionals re-

gardless of their theoretical orientation.

Keywords: meaning, purpose in life,

logotherapy, Viktor Frankl, positive

psychology

Logotherapy is based on the existential con-

cepts of Viennese psychiatrist and philosopher

Viktor E. Frankl (1905–1997). Frankl chose the

term logotherapy— based on the Greek word

“logos” as “meaning”— because his perspective

emphasizes the unique capacity of human beings

to perceive meaning. Many have been inspired by

Frankl’s most popular book, Man’s Search for

Meaning (Frankl, 2006; originally published in

English in 1959 as From Death-Camp to Exis-

tentialism), written over a 9-day period shortly

after his concentration camp liberation during

World War II (Hutzell, 2006; Klingberg, 2001).

The book contains a narrative of concentration

camp experiences and outlines some of the basic

elements of logotherapy. A sense of personal

life-meaning is critical to logotherapy, and Man’s

Search for Meaning is a prime example of how

people may reduce despair in severe circum-

stances by incorporating personal meaning

through attitudes, experiences, and behaviors.

Man’s Search for Meaning was written in 1945,

yet it was still rated as one of the top 10 books to

make a difference in the lives of American readers

as recently as the 1990s (Library of Congress,

1991). Russ Newman, American Psychological As-

sociation Executive Director for Practice, noted it to

be of particular relevance to psychologists after the

terrorist attacks of September 11, 2001 (Newman,

2002). The newest U.S. edition of the book (2006)

indicates that there are more than 12 million copies

in print. Despite its continued relevance, many men-

tal health professionals are not familiar with the

depth of Frankl’s work.

Frankl is credited with writing over 30 books.

Many were published originally in German, but

there have been translations into at least 32 lan-

guages. He published over 700 articles. An abbre-

viated version of Frankl’s vita was published by J. I.

Levinson in 2001 (Levinson, 2001). For more in-

formation about Frankl’s life and how it inﬂuenced

the formulation of logotherapy, such as his youth in

Vienna, correspondence with Freud and Adler, ex-

periences in concentration camps during World

War II, and his personal and professional develop-

ment thereafter, the interested reader is referred to

Frankl (1997b), Gould (1993), and Klingberg

(2001). The purpose of the current article is to

present various aspects of logotherapy, including

major tenets, applicability and judicious use of the

Stefan E. Schulenberg, Department of Psychology, Univer-

sity of Mississippi; Robert R. Hutzell, Knoxville, IA; Carrie

Nassif, Fort Hays State University; Julius M. Rogina, Diocese

of Nevada.

Correspondence regarding this article should be addressed to

Stefan E. Schulenberg, PhD, Department of Psychology, Uni-

versity of Mississipi, Oxford, MS 38677. E-mail: sschulen@

olemiss.edu

2008, Vol. 45, No. 4, 447–463 0033-3204/08/$12.00 DOI: 10.1037/a0014331

447

approach, therapist strategies, assessment-related is-

sues, and new research support and remaining

needs. Our intent is to provide an in-depth, yet

concise, orientation to logotherapy compiled from

often difﬁcult-to-ﬁnd publications (e.g., out-of-print

sources), incorporating recently translated texts and

current and forthcoming empirical ﬁndings. This

article represents an update as to logotherapy’s cur-

rent status in the United States, with emphasis on

logotherapy’s utility and accessibility to a broad

audience.

Meaning and Well-Being

A major reason that logotherapy has something

to offer mental health professionals across various

theoretical orientations has to do with the inﬂuence

of the meaning construct on human health and be-

havior. There is a growing basis for the relationship

between a sense of meaning and psychological and

physical well-being (Melton & Schulenberg, 2008;

Reker, 1994; Ryff, 2000; Ryff & Singer, 1998a,

1998b; Savolaine & Granello, 2002; Spiegel &

Fawzy, 2002; Zika & Chamberlain, 1992). For ex-

ample, meaning may contribute to an array of areas

related to wellness, including awareness of social

support, sense of identity and values, health-

promoting behaviors (motivation to follow

through), and stress inoculation (Ryff & Singer,

1998b; Savolaine & Granello, 2002). Moreover, in

a recent review of the literature, Melton and Schu-

lenberg (2008) noted that meaning is associated

with a range of outcomes, such as stable mood and

less psychological distress, more proactive and so-

ciable behavior, and favorable attitudes toward life

and the self. Meaning has clear signiﬁcance to the

human condition. The concepts emphasized in

logotherapy are of interest to mental health profes-

sionals striving to ﬁnd ways to help their clients

help themselves and are compatible with a variety

of existing theoretical orientations and the contem-

porary positive psychology movement.

Relationship to Other Therapies and

Positive Psychology

Several sources indicate that spirituality (in the

general sense of meaning, values, and purpose, as is

emphasized in logotherapy) is becoming increas-

ingly relevant in modern psychotherapy and medi-

cine (see DuBois, 2007, Mahoney, 2000, and

Savolaine & Granello, 2002), and there is increas-

ing evidence that spirituality is associated with pos-

itive health outcomes (Seeman, Dubin, & Seeman,

2003). The ﬁeld of psychology has shown increased

interest of late not only in spirituality but also in

resilience and positive mental health (e.g., Emmons

& McCullough, 2004; Keyes & Haidt, 2003; Lopez

& Snyder, 2003; Snyder & Lopez, 2002). Logoth-

erapy has long emphasized the importance of mean-

ing, faith, hope, humor, and many other adaptive

constructs that have become a part of positive psy-

chology; thus there is increasing support for the

utility of logotherapy concepts to researchers and

clinicians. Frankl and other logotherapists have

done much clinical work in these areas, and this

existing work can readily be incorporated into positive

psychology, as well as other, speciﬁc paradigms.

Logotherapy is often regarded as a humanistic–

existential school of thought, but it has much in

common with other paradigms. Indeed, McMul-

lin (2000) noted that “logotherapy is one of the

precursors to cognitive therapy” (p. 31), and in

describing innovative techniques used in cogni-

tive restructuring therapy (speciﬁcally perceptual

shifting), he outlined many techniques that are

consistent with those practiced by logotherapists.

Particularly relevant examples of perceptual

shifting described by McMullin include bridging

techniques, with the “Hierarchy of Values

Bridges” exercise being a prime illustration of

how clients’ personally meaningful values hier-

archy may be used to shift from old, maladaptive

beliefs into new, more adaptive beliefs.

Simi-

larly, the creative, active, and strengths-focused

aspects of logotherapy have parallels with con-

structive therapies, such as solution-focused or

narrative-focused therapies (Combs & Freedman,

1994; Furman & Ahola, 1994), in the encourage-

ment of a more positive outlook in relation to life

circumstances.

Frankl saw logotherapy, with its emphasis on

the meaning-dimension of human beings (often

termed the spiritual dimension in the broad sense

of the word) as an addition to other therapies

(Frankl, 1985, 1986, 1988, 2006), with the goal

of enhancing techniques as opposed to replacing

them. Simply put, logotherapy is intended to be

collaborative (Fabry, 1981; Kovacs, 1999), and it

has been explored in relation to a number of

Logotherapy techniques are described in a subsequent

section of this article. For additional information regarding

perceptual shifting and relevant examples, the reader is re-

ferred to McMullin (2000).

Schulenberg, Hutzell, Nassif, and Rogina

448

speciﬁc forms of therapy over the years, with

rational emotive behavior therapy (Hutchinson &

Chapman, 2005) and acceptance and commit-

ment therapy (Sharp, Schulenberg, Wilson, &

Murrell, 2004; Sharp, Wilson, & Schulenberg,

2004) being recent examples. Training in logoth-

erapy may beneﬁt clinicians from a variety of

perspectives, given its congruence with many dif-

ferent methods.

Fundamental Tenets

The fundamental tenets of logotherapy have

been documented by Frankl in a number of

English-language texts. Available books include

the most recent edition of Man’s Search for

Meaning (Frankl, 2006) and the recent translation

of On the Theory and Therapy of Mental Disor-

ders: An Introduction to Logotherapy and Exis-

tential Analysis (Frankl, 2004). Additional

English-language texts include The Doctor and

the Soul: From Psychotherapy to Logotherapy

(Frankl, 1986), The Will to Meaning: Founda-

tions and Applications of Logotherapy (Frankl,

1988), The Unheard Cry for Meaning (Frankl,

1985), and Man’s Search for Ultimate Meaning

(Frankl, 1997a).

Described in the aforementioned texts, one

construct central to logotherapy is referred to as

the tri-dimensional ontology—the conceptualiza-

tion of human beings along three overlapping

dimensions: physical, psychological, and spiri-

tual (i.e., noological, meaning oriented). It is

commonly understood that human beings often

respond with conditioned or automatic reactions

(such as self-statements, behaviors, and emo-

tions) in the ﬁrst two dimensions and that other

animals also function in the ﬁrst two dimensions.

The third dimension is emphasized in logoth-

erapy as distinguishing human beings from other

animals. However, human beings do not have to

function in the third dimension (i.e., can behave

in conditioned and automatic ways). Functioning

in the third dimension often demands a percep-

tual shift away from the typical conditioned ad-

herence to peer group expectancies or mass ad-

vertising, for instance.

In addition to the tri-dimensional ontology,

logotherapy’s basic tenets assert that (a) human

life has meaning, (b) human beings long to ex-

perience their own sense of personal life mean-

ing, and (c) human beings have the potential to

experience life meaning under all circumstances.

Frankl held the position that opportunities to

respond—in action, experience, or attitude—

exist throughout an individual’s life, and when

the chosen response is consistent with the indi-

vidual’s personal values hierarchy, the individual

experiences the longed-for sense of life meaning.

Frankl held that each individual’s personal life

meaning incorporates reaching out to an overall

order to the universe, to other human beings, and

to other animals. Responses inconsistent with

one’s personal life meaning do still have objec-

tive impact; however, they do not provide the

individual a sense of life meaning. Oftentimes,

individuals are objectively successful according

to what others (e.g., peer groups, marketing com-

panies, and cultural ideals) might ﬁnd important,

but they lack a sense of life meaning, leaving a

feeling of emptiness labeled existential vacuum.

Applicability to Mental Health Problems

In practice, logotherapy has application at each

of the dimensions of the human being (the tri-

dimensional ontology). Physiologically, logoth-

erapy is recognized for its efﬁcacy in the reduc-

tion of despair in unavoidable suffering.

Psychologically, Frankl developed useful tech-

niques, notably paradoxical intention and dere-

ﬂection, especially for problems originating in

anticipatory anxiety. From the spiritual sphere,

many people experience meaninglessness at

some point that is characterized by existential

vacuum (Frankl, 2006; Hutzell, 1990; Sahakian

& Sahakian, 1972). As such, individuals may feel

bored or apathetic, as if they are “just going

through the motions” of their lives (Frankl, 2006;

Hutzell, 1990). It is this feeling of emptiness that

can motivate people to respond to their circum-

stances, and it is their awareness of their personal

life meaning that can guide them in an objective

direction that they experience as full or satisfy-

ing. However, left unchecked, the feeling of emp-

tiness may lead to disturbances from a lack of

actualization of personal life meaning or from

conﬂicts of personally meaningful values (Frankl,

2006; Hutzell, 1990; Sahakian & Sahakian,

1972).

When the existential vacuum leads to distur-

bances, the most common problems that are pre-

dicted to ﬁll the existential vacuum are violations

of social norms, distress symptoms, and

physiological/psychological addictions. Frankl

labeled these the mass neurotic triad and spoke

Logotherapy for Clinical Practice

449

of them as aggression, depression, and addiction

(Frankl, 2006; Hutzell, 1990). Although each of

these problems can originate also from the phys-

iological and psychological dimensions, when the

symptoms originate from a sense of meaningless-

ness, they can then be treated with therapy de-

signed to work particularly with discovering

personal life meaning. The idea that meaningless-

ness is associated with alcohol (and other drug

use) is well supported in the literature (Marsh,

Smith, Piek, & Saunders, 2003). The parallels

between logotherapy and the spiritual elements of

Alcoholics Anonymous have been discussed

(Holmes, 1991; Koster, 1991), and logotherapy

has been applied in the treatment of alcohol prob-

lems (Crumbaugh, 1980, 1981; Crumbaugh,

Wood, & Wood, 1980; Henrion, 2002; Hutzell,

1984).

In addition to drug and alcohol problems, logo-

therapy has been useful with depression, anxiety,

and psychoses, as well as despair associated with

incurable illnesses (see Fabry, 1994; Frankl,

2004; Lukas, 2000; Lukas & Hirsch, 2002).

Logotherapy has applicability in a growing num-

ber of areas, such as rehabilitation (Ososkie &

Holzbauer, 2004; Starck, 1982, 2003), mental

retardation/developmental disabilities work

(Hingsburger, 1989, 1990; Schulenberg, 2003a,

2003c), pastoral psychology (Graber, 2003;

Leslie, 1965; Welter, 1987), aging (Kimble,

2000), family therapy and relationship counseling

(Crumbaugh & Henrion, 2004; Lantz, 1993;

Winters, 2002), and daily life/work-related issues

(Crumbaugh, 1973; Pattakos, 2004).

Recent World Congresses on Logotherapy

have included colloquiums on incorporating

logotherapy into the treatment of speciﬁc diag-

noses of the Diagnostic and Statistical Manual of

Mental Disorders (4th ed., text rev.; DSM–IV–

TR; American Psychiatric Association, 2000).

These protocols are subsequently published in

The International Forum for Logotherapy. Exam-

ples of recent papers have included applications

with mood disorders (Henrion, 2004; Ungar,

2002), anxiety disorders (Rogina, 2002), and per-

sonality disorders (Rodrigues, 2004; Rogina,

2004; Rogina & Quilitch, 2006).

Judicious Use of the Approach

When applications of a particular theory or

technique are discussed, the question of when the

theory or technique is contraindicated often

arises. In other words, are there situations in

which logotherapy should not be used? There is

little in the logotherapy literature on this subject

because logotherapists do not tend to think in

these terms. Logotherapists consider that each

human being has internal resources, or strengths,

that may be applied in any given situation. Logo-

therapists work with clients on helping them to

identify and access these internal resources.

However, there are situations that arise that sig-

niﬁcantly inhibit the ability of clients to identify

and access their internal resources. For example,

while the potential utility of logotherapy with

psychoses was noted previously, in extreme cases

in which individuals are experiencing severe psy-

chotic states and reality testing is poor because of

active hallucinations, delusional systems, or both,

symptoms must be managed via other methods

(e.g., medication) prior to application of logoth-

erapeutic principles. However, even in such

cases, logotherapy may be useful with friends and

family who are struggling in terms of how they

can assist their loved one. Moreover, in the above

instance, once symptoms are brought under con-

trol via other treatment, logotherapy is applicable

with regard to helping clients understand and

accept their diagnoses, work with mental health

professionals, and adhere to their treatment pro-

grams in spite of the fact that the logotherapy is

not expected to “cure” the psychosis. Thus, rather

than thinking in terms of contraindications, logo-

therapists typically think in terms of judicious use

of the approach, working in collaboration with

other strategies as necessary, to maximize the

chances of a positive treatment outcome on

the one hand and, on the other hand, to minimize

the despair that can be associated with situations in

which a positive outcome (cure) is not possible.

Logotherapeutic Strategies

The roles of the therapist. The roles of the

therapist in logotherapy include regarding clients

as fellow human beings, emphasizing their

uniqueness, teaching that they have some free-

dom to respond to their situations or problems,

and demonstrating to clients various techniques

and how they may be applied to their situations or

problems. When clients assert that they have no

freedom to respond, the therapist helps them to

search for their remaining freedom, plus encour-

ages them to take responsibility to respond to that

freedom through behaviors, experiences, or atti-

Schulenberg, Hutzell, Nassif, and Rogina

450

tude changes in ways that they ﬁnd meaningful

and adaptive.

In regarding clients as equal human beings,

therapists set a high standard by including not

only their clients’ physiological and psychologi-

cal dimensions but also their spiritual dimen-

sions, in which responsibility, morality, and per-

sonal life meaning are possible. Modernizing a

quote of the German poet Goethe, Frankl (1967)

said, “If we take man as he is, we make him

worse; if we take him as he ought to be, we help

him become it” (p. 12; see also Fabry, 1981). The

logotherapist, Joseph Fabry, paraphrased it this

way: “As long as we treat human beings as ani-

mals that can be trained, and machines that can

be manipulated, we make them into animals and

machines. If we make them aware of the re-

sources of their human spirit we help them lift

themselves into their true humanness” (Fabry,

1981, p. 11). In other words, logotherapists afford

clients the dignity of expecting them to be capa-

ble as human beings in spite of the limitations of

their current situation or problem.

In logotherapy, the client is active and partic-

ipatory, retaining responsibility to alter maladap-

tive patterns and to actualize personal life mean-

ings (Lukas, 1979/1995). The therapist assists the

client in facilitating this process. The client is

encouraged to recognize the freedom he or she

has and to implement that freedom in order to

take the energy away from the problem or symp-

tom and, instead, to move in a less problematic,

and more personally meaningful, direction. The

therapeutic relationship is one of equality and

offering opportunities to clients rather than one of

superiority and “ﬁxing” clients. As such, the ther-

apist helps clients to clarify and work toward

actions, experiences, and attitudes in which cli-

ents experience personal life meaning. The ther-

apist insists that choices are always available,

even if they are limited to choices among atti-

tudes (Lukas, 1979/1995).

Phases of logotherapy. When logotherapy is

conducted, oftentimes a series of four phases, or

steps, are followed (see Fabry, 1994, and Lukas,

1979/1995). The ﬁrst step involves differentiation

of clients from their symptoms. Clients are more

than clusters of symptoms, and in logotherapy it

is imperative that they not overidentify with a

given diagnosis. They remain human beings with

the ability to overcome obstacles and experience

personal life meaning. The second step involves

attitude modiﬁcation about the symptoms. Atti-

tudes are shifted away from overfocus on the

symptoms and shifted toward awareness of re-

maining options that are in keeping with what the

individual perceives as his or her personal life

meaning, in spite of the symptoms. Attitudes are

not forced upon clients (unless in severe cases

such as suicide); rather, in the process of working

with clients, a logotherapist facilitates the devel-

opment of adaptive attitudes that are derived

from each client’s perceived personal life mean-

ing (or personally meaningful values hierarchy).

What choices are available in response to a par-

ticular situation or problem? What directions are

most meaningful to a client? The third step in-

volves symptom reduction, which often occurs

automatically following successful completion of

modiﬁcation of attitudes. At other times, speciﬁc

techniques for symptom reduction are incorpo-

rated (e.g., coping skills, self-efﬁcacy tech-

niques). Once symptom separation has been

achieved, and more adaptive attitudes have been

discovered, clients sense that options are avail-

able, and symptoms become more manageable.

The ﬁnal step involves maintenance of mental

health through future orientation and facilitation

of continued awareness of personal life meaning

and the resultant purpose or goals in life.

Well-known therapeutic techniques. Logoth-

erapy has yielded several speciﬁc, well-known

therapeutic techniques. They focus on heighten-

ing peoples’ awareness of their personal life

meaning (i.e., their personally meaningful values

hierarchy), facilitating goal development, living

responsibly, and making adaptive choices consis-

tent with personal life meaning (Hutzell, 1990).

Attitude modiﬁcation, particularly facilitated

through Socratic dialogue (Fabry, 1994; Gutt-

mann, 1996; Hutzell, 1990; Lukas, 1979/1995;

Lukas & Hirsch, 2002), is the most often used

logotherapy technique. Socratic dialogue is a

technique whereby a therapist asks questions of

clients to facilitate internal exploration to dis-

cover personal life meanings, to explore how

these may be actualized, and to foster recognition

that choices toward these ends are always avail-

able. In the case of working with a client who

feels faced with an insurmountable problem for

which there is no solution, a logotherapist may

ask about responses to similar problems in the

past, seeking clues from the client as to person-

ally meaningful attitude modiﬁcations that may

have been used successfully to reduce the despair

of the unchangeable problem. For the client, such

Logotherapy for Clinical Practice

451

discussion prompts the rediscovery of a person-

ally meaningful hierarchy of values, thought pro-

cesses, and motivations that may be brought to

bear on the current situation. In addition to atti-

tude modiﬁcation, well-known logotherapeutic

techniques that have been developed include par-

adoxical intention, dereﬂection, and logoanalysis.

Paradoxical intention is a technique that be-

havior therapists have empirically validated, that

Frankl developed independently in the 1920s

(Ascher, 1989; Fabry, 1982; Frankl, 1975; Lukas,

1986), and that was ﬁrst published in 1939

(Frankl, 1939, 1975, 1978/1979). It has been use-

ful in cases involving recursive anxiety, such as

agoraphobia and public speaking anxiety (Ascher

& Schotte, 1999; Schotte, Ascher, & Cools,

1989; see also Schulenberg, 2003a). Components

of classical paradoxical intention, when con-

ducted by logotherapists, have been described

(Fabry, 1982; Frankl, 1975, 1985; Hutzell, 1990;

Lukas, 1982, 1986; Yoder, 1994) and include (a)

a nonmanipulative therapist– client partnership,

(b) ruling out of biological etiology, (c) educating

clients about paradoxical intention with regard to

what it is and how it works, (d) tailoring the

technique to the individual’s presenting com-

plaints, (e) participating in the fear state, while (f)

simultaneously incorporating humor to counter-

act anxiety. (In logotherapy, the spiritual

dimension—in this case through the use of

humor—is utilized to facilitate self-distancing to

allow attitude change and then behavior change.)

Dereﬂection (Frankl, 1975, 1985, 1988, 2004;

Hutzell, 1990; Lukas, 1986, 2000), as reported by

Frankl, appeared in the 1940s (in German), with

the ﬁrst English-language appearance in 1952

(Frankl, 1952, 1975). It is known that, in some

cases, people focus on the possibility of a prob-

lem or a symptom with such intensity that they

create anticipatory anxiety that actually makes

the problem or symptom worse (Frankl, 2006;

Hutzell, 1990; Sahakian & Sahakian, 1972). The

point of dereﬂection is to reorient a client’s at-

tention away from the preoccupying problem or

symptom and refocus the attention instead onto

related, highly motivating areas of personal life

meaning (Frankl, 2006; Hutzell, 1990). The re-

sulting effect is typically a reduction of the an-

ticipatory anxiety associated with the symptom or

problem in question and thus a reduction in the

symptom or problem itself (Frankl, 2006; Hut-

zell, 1990; Sahakian & Sahakian, 1972). Dere-

ﬂection is often a technique of choice when

working with sexual dysfunction (reorienting the

focus of an individual toward the pleasure of

one’s partner instead of one’s own physiological

success), and it has been argued that the inﬂuen-

tial work of W. H. Masters and V. E. Johnson in

relation to sexual problems validates Frankl’s

approach in this area (Frankl, 1952, 1975; Saha-

kian & Sahakian, 1972). Use of dereﬂection has

grown over the years such that it is used to help

clients respond to a variety of mental health dif-

ﬁculties when too much focus is placed on symp-

toms to the detriment of client strengths.

Another logotherapeutic technique, logoanaly-

sis (developed by Crumbaugh, 1973), is applied

to persons experiencing a lack of sense of per-

sonal life meaning (initially experienced as bore-

dom or apathy but with the potential to evolve

into violations of social norms, distress symp-

toms, and physiological and psychological addic-

tions). Logoanalysis offers a systematic process

of mental and written exercises to help individu-

als set a life direction and subsequent achievable

goals based on their personal life meaning. The

process lends itself well to self-help (Crumbaugh,

1973; Hutzell & Eggert, 1989; Hutzell & Jerkins,

1995) and small-group formats (Hutzell, 1983,

2002) and has yielded a variety of therapeutic

exercises. For example, the Meaning in Life

Evaluation scale (MILE; Crumbaugh & Hen-

rion, 2004; Henrion, 2001) was designed to

heighten an individual’s sense of personal life

meaning through awareness of their hierarchy

of personally meaningful values, by prompting

individuals to select from among 20 different

values via a paired-comparisons approach. Ex-

amples of values incorporated in the MILE

include friendship, acceptance, health, and so

forth. Of the 20 different values, the 5 highest

ranked by the paired-comparisons process are

then emphasized to foster meaningful goal set-

ting. The MILE facilitates active thinking and

prioritizing of values, as well as recognition as

to whether energy is being focused on the pur-

suits that are most meaningful in relation to the

participant’s values hierarchy.

Lesser-known logotherapy techniques. Many

other applications and techniques of logotherapy

have been developed that are not as widely known

as those described above. These techniques include

the Mountain Range Exercise (Ernzen, 1990; Schu-

lenberg, 2003c, 2004b), the Movies Exercise (Schu-

lenberg, 2003b; Welter, 1995), the Family Shoebox

Game (Lantz, 1993), use of stories and metaphors

Schulenberg, Hutzell, Nassif, and Rogina

452

(Moore, 1998; Schulenberg, 2003b; Welter, 1995),

and a variety of additional, assorted exercises de-

signed to clarify values and enhance meaning.

The initial idea for the Mountain Range Exer-

cise was noted by Frankl (see The Doctor and the

Soul, Frankl, 1986), and developed as an activity

by Ernzen (1990). A mountain range is drawn,

and the person completing the exercise places

people of importance to him or her (such as

friends or family members, authors, musicians,

and the like) on the various peaks. Participants

are asked what they share in common with the

individuals on their peaks, as well as whose

mountains they would like to be a part of. The

activity assists individuals in identifying posi-

tives in their lives, as well as in values clariﬁca-

tion. The activity is useful in either individual or

group therapeutic settings and has been used with

a variety of populations and treatment contexts,

such as people with alcohol-related problems,

psychiatric inpatients, and meaningful living

groups (Ernzen, 1990). It has also been used with

adolescent male sex offenders with mental retar-

dation (or developmental disabilities) and sexual

behavior problems as a means of building rapport

and discussing important treatment issues, such

as values and sexual offense histories (Schulen-

berg, 2003c, 2004b). Variations on the traditional

Mountain Range Exercise have also been pro-

posed. Pattakos (2004) suggested adapting the

Mountain Range Exercise to the work environ-

ment to clarify values and ﬁnd meaning in em-

ployment via those people who have inﬂuenced a

particular individual’s professional development.

There are two components to the Movies Ex-

ercise (Schulenberg, 2003b; Welter, 1995), both

of which focus on facilitating awareness of per-

sonal life meaning. The ﬁrst component prompts

an individual to develop a movie of his or her life,

focusing on the past up to the present time. The

second component is a movie from the present

into the future. These creative activities afford

opportunities to develop various movie aspects.

(Who will be in them? What actor or actors will

play the lead roles? What are the movies’ titles?

What kind of budgets will be available? What

will the movies be about, and what genre will

typify each ﬁlm?) These various aspects are dis-

cussed in terms of the participant’s personally

meaningful values hierarchy, identity formation,

interpersonal relationships, and key experiences

in order to help clarify the participant’s sense of

personal life meaning.

In the Family Shoebox Game (Lantz, 1993),

the therapist presents a family with a shoebox,

tape, scissors, and magazines; the task is to ad-

here magazine pictures to the shoebox to repre-

sent family values and meanings. The outside of

the box is used for values and meanings that are

presented to people outside of the immediate

family, while the inside of the box is used for

values and meanings of particular importance to

the members of the immediate family. Lantz

(1993) argued that such tasks help families in two

primary ways: ﬁrst, it gives family members a

clear task that requires communication about val-

ues and meanings that are important to the family

experience, and second, it provides the family

therapist with a means of observing family inter-

action patterns that may help or hinder a family’s

search for meaning and direction. An underlying

premise of Lantz’s (1993) applications of logo-

therapy to family therapy is that increased knowl-

edge of family values and meaning can serve to

stimulate healthy family interaction patterns,

which can, in cyclical fashion, further guide fam-

ily members toward an increased sense of values

and meaning and direction for the family as a

whole.

Logotherapists often use stories and metaphors

as one means of facilitating attitudinal change

(Moore, 1998; Schulenberg, 2003b; Welter,

1995). Frankl’s own life experiences in the con-

centration camps and his attitudinal stance to-

ward adversity (Frankl, 2006; Klingberg, 2001)

serve as one remarkable example. However, the

logotherapeutic literature is replete with stories

and metaphors that function as illustrations for

how one may adaptively deal with adversity.

Some of these stories are real-life examples of the

experiences of logotherapists. For instance, in a

case of irreversible physical loss, as was re-

counted by Long (1995), Klingberg (2001), and

Levinson (2002), a well-known logotherapist,

Jerry Long, was a teenaged baseball player whose

pitching had the attention of the professional

leagues. Then he broke his neck and became

physically dependent on others for his most basic

activities of daily living. While he recognized

that his potential for an athletic career had van-

ished, he also came to realize that much freedom

remained in other areas in which he could actu-

alize personal life meaning. He took responsibil-

ity for implementing that freedom: graduated

from high school, went on to college, and even-

tually earned his doctorate in clinical psychology

Logotherapy for Clinical Practice

453

and became a practicing logotherapist. He was

able to lead a fulﬁlling life in spite of quadriple-

gia. He often summed up succinctly his inspiring

credo for life: “I broke my neck; it didn’t break

me.” He took responsibility to do what he could,

within the freedom that he had, to establish and

maintain an attitude to pursue a personal life

meaning, in spite of his physical condition. Cli-

ents learn from such stories that regardless of

one’s circumstances, a proactive attitudinal

stance toward adversity may be chosen.

A number of additional exercises to increase

awareness of personal life meaning and to moti-

vate people toward the actualization of their po-

tentials have been described by Fabry (1988),

Mendez (2004), Pattakos (2004), and Crumbaugh

and Henrion (2004). One example contained in

Fabry’s text is the Value Auction, in which indi-

viduals are invited to consider various values that

are auctioned off and how much they wish to

“bid” on them from their limited pool of “funds.”

Another example is the Self-Appraisal Exercise,

in which people are encouraged to participate in

answering questions such as those relating to

descriptions of themselves, whom they and others

wish themselves to be, and their views as to their

potentials. Such exercises prompt reﬂection on

the consistencies between the individual’s inter-

nal and external behaviors and their sense of

personal life meaning. Mendez (2004) addition-

ally outlined a number of less well-known tech-

niques applied by logotherapists (e.g., Logo-

drama, Life Review and Life Preview, Guided

Discovery of Meaning Potentials, the Logoan-

chor, and Appealing Techniques). Finally, Pat-

takos’ (2004) exercises are geared toward per-

sonal life meaning in the workplace, while

Crumbaugh and Henrion’s (2004) activities re-

late to enhancing personal life meaning in in-

terpersonal relationships.

Psychometric Assessment of the

Meaning Construct

A variety of logotherapy tools have been intro-

duced over the years to quantify and study the

meaning construct. The best known of these are the

Purpose in Life test, the Life Purpose Question-

naire, and the Seeking of Noetic Goals test. There is

ample evidence for the internal consistency of the

global scores generated by these measures, with

coefﬁcient alphas often reported in the .80s, and

in some instances exceeding .90 (Melton & Schu-

lenberg, 2008).

The Purpose in Life (PIL) test is the earliest

and most widely studied of the well-known logo-

therapy psychometric instruments (Crumbaugh &

Maholick, 1964, 1969) and is the primary logo-

therapy measure of the degree to which an indi-

vidual experiences a sense of personal life mean-

ing. The PIL has been psychometrically reviewed

in a number of sources (e.g., Crumbaugh & Hen-

rion, 1988; Hutzell, 1987a, 1988; Melton &

Schulenberg, 2008; Reker, 2000; Schulenberg,

2004a). With regard to validity, the PIL, as is

expected, correlates positively with constructs

such as happiness, emotional stability, and extro-

version, and negatively with constructs such as

boredom proneness, anxiety, and depression

(Hutzell, 1988, 1989; Melton & Schulenberg,

2007, 2008; Robak & Grifﬁn, 2000; Schulenberg,

2004a). Such correlations are consistent with

logotherapy conceptualizations and research

studies that demonstrate the relationship between

meaning and well-being (Melton & Schulenberg,

2008; Schulenberg, 2004a).

The Life Purpose Questionnaire (LPQ; Hablas

& Hutzell, 1982; Hutzell, 1989) is another mea-

sure of the degree to which an individual expe-

riences a sense of personal life meaning, but it

was designed for use with specialized popula-

tions, such as geriatric neuropsychiatric inpa-

tients, for whom the PIL proves impractical

(Hablas & Hutzell, 1982), and the LPQ is some-

times the measure of choice over the PIL because

it uses a simple dichotomous-choice format, in

contrast to the PIL’s more complex Likert-type

response format (Hablas & Hutzell, 1982; Hut-

zell, 1989). The LPQ is the second most fre-

quently studied of the logotherapy measures. Va-

lidity support is evident via moderate-to-high

correlations with the PIL and scores that demon-

strate statistically signiﬁcant improvement in pro-

grams that incorporated a life purpose component

(Burnette, Swan, Robinson, Lester, & Little,

2003; Kish & Moody, 1989; Melton & Schulen-

berg, 2008; Schulenberg, 2004a).

The Seeking of Noetic Goals (SONG) test

(Crumbaugh, 1977a, 1977b) was developed to

assess motivation to ﬁnd meaning. There is much

less empirical data available in the published

literature on its psychometric properties (Hutzell,

1987b; Schulenberg, 2004a).

Schulenberg, Hutzell, Nassif, and Rogina

454

Empirical Support and Future

Research Needs

Frankl was well aware of the emphasis placed

on empirical scrutiny, and he encouraged re-

searchers to investigate logotherapy (Fabry,

1978/1979). Many studies have appeared with a

focus on the logotherapy paradigm, meaning in

general, and meaning-related constructs. Schul-

enberg (2003a) described research progress with

direct relevance for logotherapy, including such

areas as paradoxical intention and assessment, as

well as positive psychology constructs such as

gratitude, humor, hope, and love (all of which are

central to logotherapy).

For a recent and comprehensive source of em-

pirical articles relevant to logotherapy, the reader

is referred to Batthyany and Guttmann’s (2006)

annotated bibliography, which is an important

step in the advancement of the scientiﬁc study of

logotherapy because of its collection of abstracts

on general theory, techniques, psychopathology,

and test construction and validation. It documents

how far the empirical study of logotherapy has

come, and it is clear that meaning-related re-

search continues to advance. However, while em-

pirical studies continue to be conducted, research

needs remain a priority. Research is one means

that may facilitate the continued evolution of

logotherapy into the mainstream of the mental

health ﬁeld (DuBois, 2007; Guttmann, 1996;

Hutzell, 2000; Schulenberg, 2003a). Areas of

particular importance include expanding the psy-

chometric properties of logotherapy assessment

tools, isolating and studying speciﬁc logotherapy

tenets, conducting studies of logotherapy’s utility

in relation to speciﬁc mental health diagnoses,

and empirically examining logotherapy’s rele-

vance to clinical/disaster psychology, diverse

populations, and psychoneuroimmunology.

Logotherapy measures: Expanding the psycho-

metric foundation. One area to target for future

research is that of continuing to expand the psy-

chometric properties of various logotherapy mea-

sures with different populations and under differ-

ent contexts (Guttmann, 1996; Melton &

Schulenberg, 2008). Procedures such as explor-

atory and conﬁrmatory factor analyses may have

particular relevance for logotherapy measures

and the meaning construct in general as assessed

by these instruments (Melton & Schulenberg,

2008; Reker, 2000; Reker & Chamberlain, 2000).

For example, the PIL continues to be of interest

from a factor analytic standpoint, as in the case of

the development of psychometrically sound alter-

native forms of the measure. In a new study using

samples of undergraduate students, Schulenberg

and Melton (in press) took the 20 items of the PIL

and demonstrated how factor analysis is of assis-

tance in the assessment of the meaning construct,

in this instance, in providing preliminary support

for a replicable two-factor model of the PIL, as

well as a psychometrically viable short form that

may be useful for future research. In addition to

this study, other recent factor analytic studies

have been completed (e.g., Schulenberg &

Gohm, in press; Schulenberg, Gohm, & Ander-

son, 2006); however, such studies require repli-

cation. Samples should be drawn from increas-

ingly diverse populations (in each of the

previously mentioned studies, samples were pri-

marily female, Caucasian undergraduates), as

factor structure may vary by population.

Isolating and examining logotherapy tenets.

While there is growing research assessing various

aspects of logotherapy, more research is needed

in isolating and testing speciﬁc logotherapy pos-

tulates using increasingly stringent research de-

signs. As one example of such, Melton and Schu-

lenberg (2007) conducted a study examining

Frankl’s oft-noted postulate that boredom is one

outcome of meaninglessness. Melton and Schul-

enberg (2007) found support for the association

of the two constructs via a statistically signiﬁcant

negative correlation between the PIL and the

Boredom Proneness Scale (BPS; Farmer & Sund-

berg, 1986) with a sample of psychology under-

graduate students. In this case, higher PIL scores

(greater meaning) were associated with lower

BPS scores (less boredom proneness). However,

the study was correlational in nature, and state-

ments with regard to causation could not be

made. Since Frankl’s postulate indicates a causal

path, that is, boredom results from meaningless-

ness, stronger research designs are necessary to

further delineate the relationship (Melton &

Schulenberg, 2007). For example, one idea posed

by the authors is whether an experimental group

writing about meaningful experiences will report

less boredom and greater meaning than would a

control group writing about more neutral topics.

In addition to further studying the aforemen-

tioned relationship, empirical studies should be

designed to target other logotherapeutic postu-

lates that have been put forth over the years.

Researchers should also continue to investigate

Logotherapy for Clinical Practice

455

the meaning construct and related postulates in

different cultures, because how meaning is de-

ﬁned, and the pathways to a sense of life mean-

ing, may differ cross-culturally (Savolaine &

Granello, 2002; Schulenberg, 2003a).

Logotherapy’s relevance to mental health

problems: Serious mental illness as case in point.

Earlier in this article the incorporation of logoth-

erapy into the treatment protocols for various

DSM–IV–TR diagnoses was noted. Outcome

studies integrating logotherapy with other treat-

ment approaches to better document its effective-

ness are needed as follow-up. People with a va-

riety of forms of mental illness may beneﬁt from

logotherapy, given its focus on the motivational

effects of personal life meaning; empowerment to

be positive, hopeful, and proactive (in life and in

treatment); and encouragement to recognize the

choices that may be made in spite of unchange-

able circumstances. Given the emphasis on client

attributes and abilities, logotherapy may be par-

ticularly helpful in developing diagnostic formu-

lations, communicating diagnostic feedback to

clients (Winters & Schulenberg, 2006), and ad-

dressing questions as to how people may adap-

tively respond when facing mental illness. De-

spite their difﬁculties, clients can still have “a

personal identity, a meaning for existence, a

place in life, a worthwhile cause” (Crumbaugh,

1973, p. ix).

These concepts have become increasingly im-

portant in the mental health literature. One recent

example has to do with empowerment and indi-

viduals with serious mental illness, for whom

empowerment refers to attempts to free individ-

uals from the grip of their symptoms as well as

enhancing their ability to be proactive and for

whom serious mental illness refers to disorders

such as schizophrenia, schizoaffective disorder,

and major depression (Strack, 2008; Strack, Deal,

& Schulenberg, 2007). There is an indication that

individuals with serious mental illness perceive

recovery from their disorder in terms of areas

directly relevant to logotherapy, such as meaning,

self-determination, and hope (Strack, 2008). In

logotherapy terms they can still be “Somebody”

despite their symptoms (Crumbaugh, 1973, p. ix).

In a new study of meaning and empowerment

in individuals with serious mental illness, Strack

(2008) found through a serious of regression

analyses that empowerment is dependent on

meaning in life and psychiatric symptoms (those

reporting greater empowerment reported fewer

mental health symptoms and greater meaning).

The study offered support for the importance of

meaning to individuals with serious mental ill-

ness, particularly via its relationship to empow-

erment. These results suggest future research di-

rections, such as investigating the degree to

which meaning-related interventions directly re-

sult in increases in empowerment. In addition, it

supports the rationale that meaning is a construct

of much signiﬁcance to those with serious mental

illness and should be considered in mental health

evaluations and interventions.

Clinical/disaster psychology. Clinical/

disaster psychology is a rapidly growing ﬁeld, in

which mental health professionals are taught how

to readily assist individuals directly affected by

disasters. Often a community approach is taken,

in which clinicians respond to traumatic events in

the ﬁeld (e.g., the terrorist attacks of September

11, 2001; Hurricane Katrina). Clinicians may

work with individuals in the immediate aftermath

of a disaster or in an ongoing therapeutic capacity

in an ofﬁce setting. They work with a wide vari-

ety of disaster-related presenting complaints,

such as those that may meet formal DSM–IV–TR

criteria for Acute Stress Disorder or Posttrau-

matic Stress Disorder (PTSD).

There is a wealth of literature on the topic of

logotherapy’s utility in assisting people with

adapting to and overcoming traumatic experi-

ences, and Frankl’s own life experiences in the

concentration camps during World War II offers

added support for logotherapy’s relevance in an

array of disaster situations, such as natural disas-

ters (Halpern & Tramontin, 2007; Schulenberg,

2003a) and refugee mental health,

in which in-

dividuals may be displaced from their countries

of origin for a variety of reasons, including per-

secution on the basis of sex, racial or ethnic

background, or spiritual beliefs. Refugees must

not only deal with the traumas associated with

their displacement, but they must also deal with

postmigration stressors as well (i.e., stressors as-

sociated with moving from one country to an-

other under duress). Halpern and Tramontin

(2007) noted that Frankl’s perspective advocates

for the ability of disaster survivors to learn how

to triumph over suffering, assisting individuals

directly affected by disasters to not only discover

See Reyes and Jacobs (2006) for a primer on issues in

refugee mental health.

Schulenberg, Hutzell, Nassif, and Rogina

456

meaning in the events but also serve as a means

of facilitating posttraumatic growth.

As a follow-up to the previous section refer-

encing serious mental illness, one area to inves-

tigate systematically is logotherapy’s usefulness

as an adjunctive treatment approach with individ-

uals with Acute Stress Disorder or PTSD. There

is logotherapy literature available on these topics,

although primarily related to PTSD. For instance,

Gilmartin and Southwick (2004) and Southwick,

Gilmartin, McDonough, and Morrissey (2006)

noted a rationale for logotherapy’s application to

combat-related PTSD, describing multiple case

studies. Schiraldi (2000) noted logotherapy and

the relevance of the meaning construct to indi-

viduals with PTSD, listing several exercises to

identify and enhance meaning. There is a strong

rationale for considering logotherapy in relation

to traumatic experiences and speciﬁc diagnoses

such as PTSD; however, much of the literature

available is either conceptual or based on case

studies. Systematic outcome studies are war-

ranted to better delineate the aspects of logoth-

erapy that are of particular relevance in treating

people who have experienced traumatic events.

For example, for those diagnosed with a disorder

such as PTSD, would enhancement of meaning

result in a better prognosis? To what measurable

extent does logotherapy enhance client

resilience?

In addition, are there certain elements of logo-

therapy that could be incorporated into the Psy-

chological First Aid (PFA) training of mental

health professionals who respond to disasters?

PFA is a fundamental aspect of the training of

mental health disaster responders (Schulenberg et

al., 2008). The tenets of PFA include fostering a

sense of hope and focusing on problem solving

(being proactive), self-reliance, and strengths.

Dereﬂection may be a particularly useful tech-

nique in this respect. Finally, while logotherapy

may be integrated with PFA training that is of-

fered to mental health professionals, it would be

interesting to study whether certain aspects of

logotherapy should be included in PFA training

that is offered to paraprofessionals, such as di-

saster responders of the American Red Cross, as

PFA training tends to teach basic skills that can

be applied by mental health professionals and

paraprofessionals alike. For instance, under the

supervision of mental health professionals, could

paraprofessionals at an American Red Cross shel-

ter be trained to administer meaning-enhancing

activities to groups of individuals receiving ser-

vices? If so, how effective would such interven-

tions be? While these and other questions await

the attention of researchers, what is known is

that the meaning construct holds much promise

in terms of applicability to different types of

trauma responses and conditions, and logoth-

erapy is one speciﬁc means of facilitating the

discovery of meaning.

Logotherapy and diversity. The number of

logotherapy organizations established worldwide

exempliﬁes the fact that cross-cultural applica-

tions and implications are integral to the ap-

proach (see the Appendix for further informa-

tion). Because of logotherapy’s emphasis on

values clariﬁcation within a given person, it af-

fords mental health professionals opportunities to

consider the unique cultural context of the indi-

vidual. However, while there is much cross-

cultural, or international, literature published,

there is little research or descriptive information

available on logotherapy and multicultural issues

in the United States. A notable exception is Corey

(2005), who discusses multicultural issues in ex-

istential therapy and mentions logotherapy

speciﬁcally.

Logotherapy is one means of empowerment. It

helps people to facilitate identity development

through the recognition and clariﬁcation of val-

ues, and it galvanizes people to ﬁnd ways to deal

with adversity. For these reasons, logotherapy

should be studied empirically in relation to diver-

sity issues, such as racial and ethnic identity

formation, acculturation and acculturative stress,

racism and discrimination, and sexual orientation

or gender identity development, each of which

may inﬂuence an individual’s functioning in sub-

tle to profound ways (Hunter & Lewis-Coles,

2004; Paniagua, 2005; Schneider, 2008; Strack,

Dunaway, & Schulenberg, 2008). Logotherapy

may assist individuals in determining how much

importance they wish to place on their diversity

and how to deal with individuals and a larger

society whose values may differ markedly from

their own. Logotherapy inspires people toward

discovering their individuality, their uniqueness,

and how to feel comfortable within themselves

See Schulenberg et al. (2008) for a review of the PFA

literature and a discussion of the roles of psychologists in

clinical/disaster psychology, speciﬁcally, natural disaster

response.

Logotherapy for Clinical Practice

457

and within the larger world in which they live. As

a meaning-based approach, logotherapy may

prove to be one means of stimulating people to

respond adaptively to stressors and ﬁnd a positive

voice in the face of oppression.

With respect to women, sexism, and feminist

therapies, logotherapy also has a wide range of

applicability. However, these topics are rarely

discussed in the logotherapy literature. Feminist

therapies have traditionally focused on empow-

erment and perception of meaning, as well as

how aspects such as oppression and marginaliza-

tion affect clients (Brown, 2008). The egalitarian

partnership of client and therapist within feminist

therapies is similar to the structure of the thera-

peutic relationship within logotherapy. Brown

(2008) is one of the few authors who speciﬁcally

mentions Frankl and the relevance of Man’s

Search for Meaning with respect to these issues.

Psychoneuroimmunology. Another research

area in which logotherapy has applicability is

psychoneuroimmunology, which is a ﬁeld that

encompasses many disciplines (psychology, psy-

chiatry, immunology, endocrinology, and neurol-

ogy) in order to better understand health and

disease processes (Ader, 2007; Goodkin & Vis-

ser, 2000). The relationship between sense of life

meaning and well-being was noted previously

(e.g., Melton & Schulenberg, 2008; Ryff, 2000;

Ryff & Singer, 1998a, 1998b; Savolaine &

Granello, 2002). With regard to physical well-

being speciﬁcally, some have noted that meaning

may be of special importance in prognoses with

illnesses such as cancer (Spiegel & Fawzy,

2002). By implication, logotherapy has relevance

to the ﬁeld of psychoneuroimmunology theoreti-

cally, anecdotally, and empirically. However, the

need for additional research on the sense of per-

sonal life meaning in relation to health and dis-

ease processes remains (Ryff, 2000). As studies

in the ﬁeld of psychoneuroimmunology continue

to proliferate, logotherapy as a meaning-based

therapy could become an increasingly important

part of the empirical dialogue.

Conclusions

A central theme of this article is the idea that

meaning-centered interventions such as logoth-

erapy are of prime importance to the human con-

dition, with applicability to an array of presenting

mental health complaints. The presence of mean-

ing is associated with a range of positive out-

comes, and logotherapy is particularly attractive,

given its ability to work in collaboration with

other approaches. Frankl synthesized the thinking

of others and added his experiences (both with

human beings and as a human being) to develop

logotherapy. As a result, logotherapy has much in

common with other schools of psychotherapy.

Thus, therapists may ﬁnd that logotherapy ﬁts

with their existing ideas and work. Furthermore,

because of Frankl’s emphasis on human experi-

ence in general and spirituality in speciﬁc, his

ideas ring true to many clients.

In addition to describing logotherapy and its

applications, we sought to present examples of

well-known logotherapy techniques that clini-

cians may ﬁnd useful and to denote lesser-known

examples in the logotherapy literature. Measures

to assess meaning have been developed within

the logotherapy paradigm and were summarized

with regard to their psychometric properties. Fi-

nally, research progress was discussed, along

with the need for expanding the psychometric

properties of logotherapy measures and advanc-

ing the study of logotherapy in relation to speciﬁc

mental health diagnoses and diverse populations,

as well as growing ﬁelds such as clinical/disaster

psychology and psychoneuroimmunology.

The Appendix includes a brief discussion of

logotherapy research, educational, and training

resources. While one may learn about the theo-

retical, descriptive, and empirical underpinnings

of logotherapy through such outlets, and how

various techniques are applied, each therapist–

client pairing forms a unique dyad with its own

unique challenges. When asked what advice he

would give to clinicians interested in logoth-

erapy, J. C. Crumbaugh encouraged them to uti-

lize dereﬂection to help individuals focus on suc-

cesses (toward the positives), to ﬁnd what will

work in a speciﬁc situation (Schulenberg & Hen-

rion, 2005). For logotherapy to be conducted

successfully, clinicians must not only study logo-

therapy and work to apply it clinically, they must

learn to live logotherapy as well; and each day,

each moment, presents new opportunities to live

meaningfully—this is the essence of logotherapy.

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462

Appendix

Research, Training, and Educational Resources in Logotherapy

To enhance the study of logotherapy, a web-

based logotherapy research discussion group has

been established by the scientiﬁc board of the

Viktor Frankl Institute of Vienna (http://

logotherapy.univie.ac.at/e/news_platform.html).

In addition to facilitating discussion, the website

includes an annotated list of meaning-related

measures of interest to researchers.

There are logotherapy organizations world-

wide, and these often offer training and educa-

tion; a good place to start looking for these is the

Logotherapy Vienna website at http://

logotherapy.univie.ac.at/. The website lists over

50 societies and institutes in 24 countries

(DuBois, 2007). In the United States, training is

offered through the Viktor Frankl Institute of

Logotherapy, which currently headquarters out of

Texas and maintains a website at http://

www.logotherapyinstitute.org/. Training in the

United States includes introductory (providing a

basic foundation for principles of logotherapy),

intermediate (focusing on applications of logoth-

erapy, such as attitudinal change), and advanced

(focusing on Franklian theory and therapy of

mental disorders) courses to reach Associate Cer-

tiﬁcation. In addition, through advanced super-

vised study, qualiﬁed mental health professionals

may achieve Diplomate Clinician or Educator/

Administrator Certiﬁcation. The institute’s logo-

therapy curriculum is available for purchase for

educational use in the form of a set of CDs (Rice,

Graber, Pitts, Rogina, & Sjolie, 2005). The U.S.

institute also conducts a bi-annual world congress

on logotherapy, which provides a forum for the

exchange of information, research, and practical

applications. Finally, The International Forum

for Logotherapy, published since 1978, is a peer-

reviewed journal that speciﬁcally focuses on the

theoretical, descriptive, and empirical aspects of

logotherapy.

Logotherapy for Clinical Practice

463

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Full-text available

Jun 2023

Caregivers for dialysis patients have endured tremendous burden and responsibilities in their daily lives from caregiving. Interventions that cater to them are essential, considering that they play an essential role in the illness management of patients. The purpose of this review is to examine the interventions implemented among the caregivers caring for patients diagnosed CKD and its effectiveness in alleviating the caregiver burden. PRISMA-ScR checklist was utilized as the reporting standard. Past studies were searched in four major citation databases (MEDLINE, Cochrane Library, PubMed, and Web of Science) in the timeframe of February 2022. Nine studies were identified, comprised of randomized controlled trials (RCTs) and quasi-experimental studies. The types of intervention programs reviewed were educational programs, supportive programs, family-centered programs, and psychological interventions. The evidences have suggested that these programs are effective in reducing caregiver burden among the caregivers of CKD patients.

A Psychometric Validation of the Claremont Purpose Scale with an Emerging Adult University Student Population

Article

May 2023

Purpose is a key protective factor for well-being, resilience, and satisfaction with life. The Claremont Purpose Scale (CPS) was developed by Bronk and colleagues with adolescents and emerging adults to measure three dimensions of purpose: Meaning, Goal-Directedness, and Beyond-the-Self. The psychometric properties examined in the original scale development paper were replicated with our independent, emerging adult college student sample: confirmatory factor analysis (CFA) of a 3-factor model, good-to-excellent internal consistency, convergent validity with a measure of general perceived meaning in life (MLQ-P), and discriminant validity with a measure of self-reported depression (DASS-21-D). Additional psychometrics examined in this study were test–retest reliability, a 1-factor CFA model, correlations with stress and anxiety, and descriptive statistics that had not yet been reported in the literature. Beyond-the-self items did not load well onto the overall factor in the 1-factor model, and their correlations with other scales (MLQ-S, DASS-21 subscales) differed significantly from the correlations between these other scales and the CPS total, General Meaning, and Goal-Directedness scores. Implications of these data include strong support for the use of each subscale as a distinct, psychometric index, and we recommend the total scale score not be used as a measure of overall purpose. Clearly, there are separate, but related, facets to this measure that, while positive, undermine the utility of a global purpose score. A slightly changed naming of the CPS to the “Claremont Purpose Scales” could promote their use as three separate scales instead of a single, total scale score.

Purpose in Life: Addressing Transdiagnostic Psychopathologies Concerning Patients' Sense of Purpose

Article

Apr 2023

Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.

Developing the Meaning of Life Model: Introduction of the Main Components of the Model Structure

Preprint

Jan 2023

The debate about the meaning of life in the literature has been around for a while and portraits a fundamental human need to find a personal path of existence. The meaning of life phenomenon purpose lies in its impact on the psychological wellbeing. Knowing your purpose in life can make it more structured and in balance, therefore more meaningful and comprehensible. However, in the existing body of the academic literature meaning of life is discussed more from the philosophic perspective rather than a practical area, which is not helping to solve the global issues of increasing mental health problems. When social and emotional wellbeing is being affected, it is urgent to apply a practical approach to effectively overcome these states. Introduction of a new, holistic meaning of life model is an attempt to offer a practical solution for society to maintain their mental health through awareness of their life’s purpose. Previously in the pilot study (Dombrovskis, 2017) in a sample group of 100 citizens of Latvia who self-reported being in a crisis situation at the given moment, using qualitive analysis the first component for the model structure was identified – antecedent. In our research antecedent is defined as something that triggers certain action, so in crisis situation person can regain a structure and stability in life. We found 8 different antecedents that trigger behavior of those affected by crisis: achievements; power; success; development; freedom; uniqueness; interesting life and fleeing. To continue to explore other components for our model in the setting of Latvia, this study aims to investigate the demographic and personality related variables that may serve as antecedents and as such become one of component in our model structure. The study used a sample of residents of Latvia representing the total population of 1,110 respondents (633 women, 57%, and 477 men, 43%) who have completed the self-assessment questionnaire Meaning of life scale (MOLS) (online and frontally) designed by the authors on their satisfaction with different factors regarding the meaning of life. Average age of respondents (M=33.88; SD=8,527) varied from 18 to 67. The exploratory and confirmatory analysis confirms the data regarding existence of totally 16 factors: 8 antecedents identified in the pilot study and 8 new antecedents identified in the present study - family relations; level of income; relations with friends/acquaintances; state of health; organization of free time; career growth (achievements); sexual life quality and quality of education. Findings confirm a model’s structure to be complex phenomenon consisting of various components. However, findings suggest that more research should be done to fill the following gaps: 1) identify actions, which are triggered by 16 antecedents; 2) figure out F1, F2 and F3 factor role in the model structure.

Immigration and Logotherapy: Addressing Mental Health Problems among Muslim Immigrants in Europe

Conference Paper

Full-text available

Sep 2022

Depression, stress, anxiety disorders, and PTSD are some of the mental health problems that are prevalent among immigrant populations despite being underdiagnosed. Stigma, difficulties in adapting, cultural barriers, and reduced access to mental health support can seriously hamper their ability to build resilience and recover. Other limitations include assuming that therapies can be universally applied, the lack of sufficient evidence on mental health issues of this population, and the use of therapeutic models developed on Caucasian populations. Here, professional guidance to find the meaning of life through interventions such as logotherapy could help them in this process. The present work systematically reviewed studies investigating the effectiveness of logotherapy in diverse populations and its relevance to a Muslim immigrant population in Europe. Following PRISMA guidelines and the keywords ‘logotherapy, mental health problems, immigrant, and treatment’, the search identified 16 relevant studies conducted since 2005. The studies revealed that logotherapy could be implemented through paradoxical intention, de-reflection, Socratic dialogue, and attitude modification. All these techniques have the potential to help the client to realize long-term relief for underlying stressors associated with migration and settling in a new location. Though data on logotherapy are still scarce, it is evident that it deserves more research so that a structured, evidence-based, and effective therapy for Muslim immigrants in Europe can be developed and tested. In this regard, we propose that the four logotherapy techniques have huge potential in helping psychiatrists develop an effective therapy for mental health problems among these immigrant populations confronting adversity.

Viktor Frankl’s (Centripetal) Leisure: an initial exploration

Article

Aug 2023

Rodney B. Dieser

Growing from Shame: Positive Psychology Interventions as a way to treat Moral Injury informed by acts of Commission and Omission

Article

Jun 2023

Samuel Dickinson

Mediating effects of meaning in life on the relationship between family care, depression, and quality of life in Chinese older adults

Article

Full-text available

Apr 2023

Background: The study explored sources of meaning in older adults and the action path among family care, meaning in life, quality of life, and depression. Materials and methods: We investigated 627 older adults using the Sources of Meaning in Life Scale for the Elderly (SMSE), the Family Care Index (APGAR), the Center for Epidemiological Studies Depression Scale-10 (CES-D-10), and the EuroqOL-5 Dimensions (EQ-5D). Results: Scores categorized 454 older adults with good family function, 99 with moderate, and 47 with severe family dysfunction; 110 older adults had depression. The structural equation model showed that family care affected the quality of life and depression by influencing meaning, and depression had a significant negative effect on the quality of life (P < 0.05). The model was a good fit for the data (χ2/df = 3.300, SRMR = 0.0291, GFI = 0.975, IFI = 0.971, TLI = 0.952, CFI = 0.971, RMSEA = 0.062). Conclusion: Meaning in life is an intermediary factor that affects depression and quality of life in older adults. Family care had a significant positive impact on SMSE and a negative influence on depression. The SMSE effectively clarifies the sources of meaning in life and can be used to improve meaning and promote mental health in older adults.

Is Humor a Meaning Making Process? Investigating the Effects of Absurd Humor and Mortality Salience on Meaning in Life, Moral Identity, Belongingness, and Belief in a Just World

Article

Apr 2023
PSYCHOL REP

Both mortality salience and absurd humor have been found to elicit fluid compensation - the automatic process of strengthening unrelated beliefs in response to a meaning threat. Previous research has suggested that perceiving absurd humor to be funny decreases people's tendency to fluid compensate, suggesting that humor is a meaning-making process. However, these results may have been confounded by mortality salience effects. Furthermore, few studies have investigated the effects of absurd humor and mortality salience on multiple beliefs. In the current study, we aimed to conceptually replicate previous research on the fluid compensatory effects of absurd humor and mortality salience under more stringent conditions and in response to a wider variety of beliefs. Participants (N = 590) recruited via MTurk were randomly assigned to a reading condition and thereafter completed a series of measures of meaning in life, moral identity, belongingness, and belief in a just world. Participants found humor in each reading condition and did not fluid compensate, suggesting that humor is a meaning-making process. Implications and directions for meaning making and humor research are discussed.

A Logotherapy Treatment Protocol for Major Depressive Disorder

Article

Full-text available

Mar 2002

Maria Marshall

Discusses contributions of V. E. Frankl's logotherapy in the diagnosis and treatment of patients with major depression. Frankl's dimensional ontology distinguishes between endogenous depression, reactive depression, and depression accompanying Noogenic Neurosis. A logotherapeutic treatment protocol is presented, consisting of 3 phases: diagnostic phase, therapy phase, and follow-up phase. The therapy phase includes the need to start with attention to the safety of the patient, modification of attitudes, and the use of metaphors. Emphasis is placed on teaching patients to form new attitudes toward depressive symptoms. A case study of a 28-yr-old female patient with severe depressive symptoms is included.

Exploring Existential Meaning: Optimizing Human Development Across the Life Span

Book

Full-text available

Jan 2000

Handbook of Cognitive Therapy Techniques

Article

Jan 1988
J Cognit Psychother

An experimental study in existentialism: The psychometric approach to Frankl's concept of noogenic neurosis†

Article

Apr 1964
J CLIN PSYCHOL

Paradoxical intention and recursive anxiety

Article

Jan 1989

L.M. Ascher

The Oxford Handbook of Positive Psychology, (2 Ed.)

Book

Sep 2012

The Oxford Handbook of Positive Psychology studies the burgeoning field of positive psychology, which, in recent years, has transcended academia to capture the imagination of the general public. The book provides a roadmap for the psychology needed by the majority of the population-those who don't need treatment, but want to achieve the lives to which they aspire. The articles summarize all of the relevant literature in the field, and each is essentially defining a lifetime of research. The content's breadth and depth provide a cross-disciplinary look at positive psychology from diverse fields and all branches of psychology, including social, clinical, personality, counseling, school, and developmental psychology. Topics include not only happiness-which has been perhaps misrepresented in the popular media as the entirety of the field-but also hope, strengths, positive emotions, life longings, creativity, emotional creativity, courage, and more, plus guidelines for applying what has worked for people across time and cultures.

The pleasure principle and sexual neurosis

Article

Jan 1952

V.E. Frankl

The Life Purpose Questionnaire: An alternative to the Purpose-in-Life test for geriatric, neuropsychiatric patients

Article

Jan 1982

Refugee Mental Health

Article

Oct 1991

John W. Berry

Manual of instructions for The Purpose In Life Test

Book

Jan 1969

Logotherapy for clinical practice

Abstract

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