Logotherapy,
Meaning Therapy,
& Spirituality
©Paul T. P. Wong
18TH ANNUAL
CONFERENCE
OF JAPANESE
ASSOCIATION
OF CLINICAL
THANATOLOGY
Overview

The role of meaning in spiritual care for cancer
patients

Dr. Frankl’s Logotherapy & his concept of
spirituality
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Wong’s Meaning Therapy in tapping into the
human capacity for meaning making
Breitbart’s Meaning-Centered Group
Therapy for Cancer Patients
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Session 1 – Concepts of meaning and sources of meaning
Session 2 – Cancer and meaning
Session 3 – Meaning and historical context of life
Session 4 – Storytelling, life project
Session 5 – Limitations and finiteness of life
Session 6 – Responsibility, creativity, deeds
Session 7 – Experience, nature, art, humor
Session 8 – Termination, goodbyes, hopes for the future
Itami’s Meaningful Living Therapy
with Cancer Patients
Reynolds (1989) - The basic principles for the patient of M.L.T. are:
1. To take major responsibility in the fight against the disease.
2. To live a life devoted to fulfilling daily goals.
3. To be helpful to others.
4. To undergo training in coping with the anxiety associated with
illness and the fear of death.
5. To contend with death naturally and constructively by accepting
the principle that everyone inevitably dies.
6. To avoid being a "sick person" even though ill.
7. To live out the remainder of life positively, undefeated by the
disease.
Katsutaro Nagata

WHO professor,
psychosomatic medicine
and psychopharmacology
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Logotherapy approach to
pain & illness
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Logotherapy as effective
treatment for chronic
pain
Dimensions of Suffering
(Mak, 2007)
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Physical – physical symptoms & pain
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Psychological – helplessness, hopelessness, &
uncertainty
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Social – isolation & relational conflict
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Spiritual – lack of meaning in life
The Good Death
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A comfortable & pain-free death
A harmonious death
A meaningful death
A hopeful death
A peaceful death
Aspects of Spirituality
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Pertain to ultimate meaning and purpose
Discover a sense of meaning, calling, & significance
Involve certain spiritual practices
May involve a set of religious beliefs & rituals
Believe in a Higher Being and a spiritual reality
Experience sacred moments
Cultivate a transcendental connection
Seek spiritual direction & formation
An Instrument Approach to
Spiritual Care:
(Based on what you say and do with patients)
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Addressing patients’ spiritual needs
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Addressing patients’ existential needs
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Taking a spiritual history of patients
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Incorporating appropriate spiritual practices
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Involving chaplains and spiritual leaders
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Involving the appropriate faith community
A Transformative Approach to
Spiritual Care:
(Based on what you say and do with patients)
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The healing silence – listening to the inner voice
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The healing touch – touching the heart & soul
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The healing connection – establishing an I-You
relationship
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The healing presence – providing a caring,
compassionate presence
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The healing process – nurturing spiritual growth
Coping with Death Anxiety
Elizabeth Kubler-Ross’s (1969) five stages of coping
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Denial –
Death avoidance and extreme sports
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Anger – Aggression, violence and terrorism
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Bargaining – Doing good deeds or worshipping gods
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Depression – Disengagement and isolation
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Acceptance –Engagement in life
Three Types of Death Acceptance
(Wong, Reker, & Gesser, 1994)
1.
Neutral - facing death rationally as an
inevitable end of every life
2.
Approach - accepting death as a gateway to a
better afterlife
3.
Escape - choosing death as a better
alternative to a painful existence
Positive Death Acceptance
“Death Acceptance is the only antidote to Death Anxiety.”
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Acceptance of one’s life as worthwhile
Readiness to let go things of this world
Recognition of the spiritual connection with a
transcendental reality
Hope in sharing spiritual life with loved ones
for all eternity
Pathways to Death Acceptance
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Life review (Wong, 1995)
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Self-acceptance (Wong, 1998)
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Religious/spiritual beliefs (Wong, 1998)
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Embracing one’s own life
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Death education
To contemplate our death is to contemplate our
life that leads to death.
Coping with Death Anxiety
The Japanese Perspective
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Naikan Therapy – focuses on inner looking &
self-cultivation; life review of one’s relationship
with a significant other, resulting in a more
realistic sense of self & relationships
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Morita Therapy – learning to accept & live
with negative emotions without judgment,
focuses on taking control of own behaviour in
spite of how one feels
The Life-Death Connection
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“To solve the problem of death, one must first
solve the problem of life, living life” (Dennis
Yoshikawa)
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“To be prepared for death is to be prepared
for living; to die well is to live well” (Konosuke
Matsushita)
“ Living well and dying well
involve enhancing one’s sense
of self, one’s relationships with
others, and one’s understanding
of the transcendent, the
spiritual, the supernatural….”
(Kuhl, 2002)
Living and Dying well through
Meaning & Spirituality
•
Human beings are born with the innate need for meaning &
spirituality.
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Finding meaning and purpose can make a big difference in
how we live & how we die.
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The psychology of meaning management helps deepen our
spirituality and existential understanding.
•
Meaning management helps construct an effective
psychological and spiritual model.
•
Meaning management motivates us to embrace & assume
responsibility for our personal lives.
Viktor Frankl &
the Medical Ministry
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Logotherapy is adjunct to medical
treatments.
Healing needs to occur at the spiritual
level.
Needs to address questions of suffering
and death
Meaning can be found in the most
horrible situations.
Needs to awaken the defiant human
spirit
For more information, visit
www.meaning.ca
What is Logotherapy?
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Logotherapy literally means therapy through
meaning.
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It is a spiritually-oriented approach towards
psychotherapy.
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Existential analysis is needed to make the clients
aware of their spirituality and capacity for meaning.
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“Inasmuch as logotherapy makes him aware of the
hidden logos of his existence, it is an analytical
process” (Frankl, 1984, p. 125).
Existential Vacuum
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Many people seek healing of inner emptiness
because of a felt sense of existential vacuum.
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Frankl believed that existential vacuum may
lead to both the tragic triad and neurotic triad.
Meaning therapy is uniquely suitable to address
these mental health issues.
The Tragic Triad
pain
guilt
death
The Neurotic Triad
depression
aggression
addiction
The Basic Tenets of Logotherapy
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Freedom of will: Not only freedom from
some negative condition but also freedom to
something rewarding.
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Will to meaning: Striving to find a meaning in
one’s life is the primary motivational force.
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Meaning of life: One can always discover
meaning in life regardless of life’s
circumstances.
Freedom & Responsibility
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Logotherapy emphasizes the responsible &
meaningful use of freedom.
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Human existence can only be understood in
terms of responsibility.
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The will to meaning is based on a sense of
responsibility.
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Responsibleness means meeting the demand
quality of every situation.
The Will to Meaning
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It is the primary motivation for living.
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Everyone needs to find the true meaning of
one’s own life.
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Will to meaning is essential for resilience and
well-being to the extent that it means one’s
capacity to live in spite of pain & suffering
(similar to the will to live, “sei no yokubo”, in
Meaningful Life Therapy)
Meaning of Life
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Life has meaning under all circumstances. It is
our responsibility to respond to life’s demands.
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Each person must discover the meaning
potential of each situation.
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The ultimate meaning lies in its pursuit.
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The situational meaning can be experienced
through three avenues of value.
Three Basic Pathways to
Meaning
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Creative value: giving something to the world
through creative works.
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Experiential value: receiving something from
the world through appreciation and gratitude.
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Attitudinal value: taking a heroic stand
towards suffering and fate.
Schematic Representation of Human Dimensions
l
l
l
l
l
Will to
Meaning
Moral
Understanding
Spiritual
Beliefs and Values
Positive
Attitudes in
Suffering
Spiritual
l
l
Noetic
l
PSYCHOLOGICAL
l
l
l
l
l
l
l
Emotional States
Stress Reaction
Physical Pain
Sensation
Awareness of the
Spiritual Realm
Capacity to Know
God
Encounter with the
Transcendent
Perception
Learning &
Meaning
Higher
Cognitive
Social Processes
Psychosomatic
l
Biological
l
l
PERSONHOOD
Sociocultural Context
Physical
Health
Biological
Drives
Biochemical
Processes
Noetic Dimension
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The dimension of the human spirit
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It is the healthy core or “medicine chest” of
logotherapy.
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It contains uniquely human attributes, such as:
will to meaning, ideals, creativity, faith, love,
conscience, self-detachment, self-transcendence,
humor, goal-striving, and taking on
commitments & responsibilities.
What is Meaning Therapy?
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It evolves from logotherapy and cognitive
behavioral therapy.
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It is part of the third wave of
psychotherapy which involves powerful
new concepts such as acceptance,
commitment, meaning-making, and restorying.
The Defining Characteristics of
Meaning Therapy
Integrative/holistic
 Existential/spiritual
 Relational
 Positively oriented
 Multicultural
 Narrative
 Psycho-educational
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Meaning Therapy is Integrative
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Existential meaning – Logotherapy & Existential Therapy
Cognitive meaning – Cognitive-Behavioural Therapy
Narrative meaning – Narrative Therapy
Positive meaning – Positive Psychotherapy
Cultural meaning – Cross-cultural & Indigenous Therapy
The Motto of
Meaning Therapy
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Meaning is all we need.
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Relationship is all we have.
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It is difficult to implement effective
interventions when either one of the above
conditions is missing.
The Therapeutic Presence
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Who we are is more important than what we say.
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Rogers’ three pre-conditions need to be the personal
characteristics of counsellors.
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Personal wholeness of the therapist is important.
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The messenger is the message.
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The therapist is the therapy.
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The counsellor brings a healing presence.
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The counsellor models meaningful living.
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The counsellor practices counselling by osmosis.
Healing through Relationship
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Building rapport and trust is essential to effective therapy.
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Authentic and caring relationships has more healing
power than therapeutic alliance.
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Accepting resistance and negative reaction as part of the
healing process.
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The ground rule of respect and caring applied to both the
therapist and the client.
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Recognize that each individual is both unique and similar.
Different Levels of Relating
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At the social level, two strangers get to know each other
in a trusting and non-judgmental environment.
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At the existential level, two human beings share their
common humanity.
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At the professional level, the therapist is responsible for
achieving desirable therapeutic goals.
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Therapy involves the reciprocal influence between the
therapist and the client.
Therapeutic Goals
To awaken the client’s sense of
responsibility and meaning.
 To achieve a deeper understanding of the
problem from a larger perspective.
 To help the client discover their true
identity and place in the world.
 To help the client pursue what really
matters in life.
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Therapeutic Goals Cont’d
To grow and develop the client’s full potential.
 To make life better for self and others.
 To transform a victim’s journey into a hero’s
adventure.
 To discover meaning and hope in boundary
situations.
 To learn principles and skills to achieve positive
outcomes and transform negative outcomes
through meaning.
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The Art of Questioning
Responsibility questions
 Choice questions
 Trajectory questions
 Quest questions
 Eight enduring existential questions
 Magic questions
 Diagnostic questions
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Eight Enduring
Existential Questions
1.
2.
3.
4.
5.
6.
7.
8.
Who am I?
How and where do I find happiness?
What should I do with my life?
How can I avoid making the wrong choices in the major
areas of my life?
Where do I belong?
What is the point of all my striving?
What will happen to me after I die?
What would make my life more meaningful and
significant?
The PURE Principles
The four treasures of Meaning Therapy:
 Purpose
– the motivational component
 Understanding – the cognitive
component
 Responsible action – the behavioral
component
 Enjoyment – the affective component
The ABCDE Strategy
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Accept and confront the reality -- the reality principle.
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Believe that life is worth living – the faith principle.
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Commit to goals and actions – the action principle.
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Discover the meaning and significance of self and
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Evaluate the above – the self-regulation principle.
situations – the Aha! principle.
Acceptance
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Accepting what cannot be changed.
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Accepting reality, limitations, loss, trauma,
existential givens.
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Acceptance does not mean giving up or
resignation.
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Confronting one’s worst fears with courage and
tragic optimism.
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Transcending and transforming the tragedy.
Levels of Acceptance
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Cognitive acceptance
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Emotional acceptance
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Realistic acceptance
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Integrative acceptance
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Existential acceptance
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Transcendental acceptance
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Transformative acceptance
Belief
Affirming one’s ideals and core values.
Believing
in the intrinsic value and meaning
Believing
in an Ultimate Rescuer or Higher
Believing
in the eventual triumph of good
of life
Power
& justice
Commitment
Moving forward and carrying out one’s responsibility
with determination
Doing
what needs to be done regardless of feelings
or circumstances
Striving
to fulfill one’s responsibility no matter what
Enduring
hardship and pain for a worthy cause
Practicing
the PURE principle
Pursuing
realistic goals
Re-authoring
one’s life story
Discovery
Learning something new about the self and life.
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Digging deeper, exploring farther, and
searching higher.
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Discovering one’s hidden courage and
strength.
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Discovering the power of faith and spiritual
resources.
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Grasping the complexities of life and people.
Evaluation
Savoring small successes or re-assessing one’s
progress.
Feeling
relief that the worst is over.
Savoring
the moments of small success.
Reflecting
and reviewing one’s life.
Receiving
feedback from others.
Conducting
assessments and making adjustments.
SOURCES OF MEANING
According to Wong (1998), there are 8 sources of
meaning and the good life.
1.
Achievement
5.
Relationship
2.
Acceptance
6.
Religion
3.
Transcendence
7.
Fairness
4.
Intimacy
8.
Positive emotions
Definition of a
Meaningful Moment
1.
It is deeply felt – It touches your emotions in a deep
and lasting way. More than a fleeting feeling, it reaches
your innermost being.
2.
It is deeply processed – It involves deeper layers of
meaning beyond the factual and superficial.
3.
It is enlightening – It provides a solution to some
puzzling problems or leads to some new discovery.
4.
It is transforming – It enriches your life, changes
your life’s direction or restores a sense of purpose and
passion to your life.
The Meaning Mindset
1.
Life has intrinsic meaning and value.
2.
My ultimate purpose is self-transcendence.
3.
I can live at a deeper level by detecting the meaning &
significance of any situation.
4.
I can live at a higher plane by serving a higher purpose
& being attuned to the transcendental realm.
5.
I can live fully by integrating by my potentialities with
my vulnerabilities moment by moment.
Life Orientation Scale
1.
2.
3.
4.
5.
6.
7.
I can find something meaningful or significant in everyday events. 1 2 3 4 5
There is a reason for everything that happens to me. 1 2 3 4 5
There is no ultimate meaning and purpose in life. 1 2 3 4 5
There is no point in searching for meaning in life. 1 2 3 4 5
No matter how painful the situation, life is still worth living. 1 2 3 4 5
The meaning of life is to “eat, drink and be happy”. 1 2 3 4 5
What really matters to me is to pursue a higher purpose or calling regardless
of personal cost. 1 2 3 4 5
8. I would rather be a happy pig than a sad saint. 1 2 3 4 5
9. I am willing to sacrifice personal interests for the greater good.
12345
10.Personal happiness and success are more important to me than achieving
inner goodness and moral excellence. 1 2 3 4 5
Meaning-mindset
Meaningful
moments
PURE Framework
Sources of
meaning
Frankl’s 3 basic
tenets and values
of meaning
Patterns of Resilience
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Recovery: Bouncing back and returning to
normal functioning.
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Invulnerability: Remaining relatively
unscathed by the adversity or trauma.
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Post-traumatic Growth: Bouncing back
and becoming stronger.
Four Life Trajectories
Elements of Tragic Optimism
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Acceptance of the worst.
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Affirmation of the value and meaning of life.
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Self-transcendence (altruism).
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Faith in God and others.
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Courage to face adversity.
Conclusion
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Meaning is a key component in spiritual care for
cancer patients.

Logotherapy focuses on the responsibility to
discover & fulfill the will to meaning through
self-transcendence & authentic living.

Meaning therapy is integrative. It focuses on the
human capacity for meaning-seeking &
meaning-making.