Meaning-Centered
Counselling & Spiritual Care
© Paul T. P. Wong, Ph.D., C.Psych
The Alberta Pastoral Care Association
45th Annual Conference
April 15 - 16, 2013
Overview
• The general characteristics of Meaning
Therapy (short name of MeaningCentered Counselling & Therapy)
• The basic the principles and practices of
Meaning Therapy
• Meaning Therapy & Spiritual Care
Wong’s Meaning Therapy
• It evolved from logotherapy and
cognitive behavioral therapy.
• It is part of the third wave of
psychotherapy which involves
powerful new concepts such as
acceptance, commitment, meaningmaking, and re-storying.
From Logotherapy to Meaning
Therapy
• Logotherapy was an adjunct to
psychotherapy and medical practice.
• Meaning Therapy is an integrative
psychotherapy.
• Meaning Therapy elevates the motif of
meaning into a symphony.
• Meaning Therapy is more anchored in
empirical research.
Existential Positive Psychology
(EPP)
• By definition, EPP integrates the positive
potentials & negative potentials of
human existence.
• The main thrust of EPP is the positive
transformation of life as a whole.
Sources of Positivity
• God is the source of all blessings
• Life itself is a gift from God
• The human potential for growth,
spirituality, & goodness
• There is beauty, truth, & kindness in the
world
• Positive emotions & traits
Sources of Suffering
• Natural disasters
• Man-made disasters
• Existential anxieties
• Spiritual deadness
• Inner brokenness
• Breakdown of relationship
• Physical illness & pain
Dimensions of Suffering
(Mak, 2007)
• Physical – physical symptoms & pain
• Psychological – helplessness, hopelessness,
& uncertainty
• Social – isolation & relational conflict
• Spiritual – lack of meaning in life
The Challenge of
Meaning Therapy
• How to tap into sources of positivity to
transform or transcend negativity &
suffering
• How to capitalize on the human capacity
for spirituality & meaning seeking/making
to achieve personal & social
transformation
The Motto of Meaning Therapy
Meaning is all we have;
relationship is all we need.
• Human beings are meaning seeking/making
beings, living in a world of meaning.
• Relationship is all we need to help clients:
 Relationship itself heals.
 How to relate to self & others is the basis for healthy
living.
 Every problem exists in a relational network.
Meaning as the Central Construct
Meaning Therapy integrates different approaches
of psychotherapy with meaning as the central
construct.
 Cognitive Meaning – Cognitive Behavioural Therapy
 Existential/Spiritual Meaning – Existential Therapy &
Spiritual Care
 Narrative Meaning – Narrative Therapy
 Unconscious Meaning – Psychoanalytic Therapy
 Cultural Meaning – Cross-Cultural Therapy
The Defining Characteristics of
Meaning Therapy
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Integrative/holistic
Existential/spiritual
Relational
Positively oriented
Multicultural
Narrative
Psycho-educational
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 my potentialities
with my vulnerabilities moment by moment.
Life Orientation Scale
1. I can find something meaningful or significant in everyday events.
12345
2. There is a reason for everything that happens to me. 1 2 3 4 5
3. There is no ultimate meaning and purpose in life. 1 2 3 4 5
4. There is no point in searching for meaning in life. 1 2 3 4 5
5. No matter how painful the situation, life is still worth living. 1 2 3 4 5
6. The meaning of life is to “eat, drink and be happy”. 1 2 3 4 5
7. 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
Principles of Relationship
• Relationship is more than therapeutic
alliance
• Relationship is more than relational
therapy (overcoming relational deficits)
• The principles of relationship include
1. Presence
2. Rogerian principles
3. Learning new patterns of relating
The Therapeutic Presence
• Who we are is more important than what we say.
• Rogers’ three pre-conditions need to be the
personal characteristics of counsellors.
• Personal wholeness of the therapist is important.
• The messenger is the message.
• The therapist is the therapy.
• The counsellor brings a healing presence.
• The counsellor models meaningful living.
• The counsellor practices counselling by osmosis.
Rogerian Principles
Healing through Relationship
• New patterns of relating based on trust &
authenticity
• The dynamic of moment-to-moment
interaction provides windows for therapy
• Accepting resistance and negative reaction
as part of the healing process
Healing through Relationship
(Cont.)
• The ground rule of respect and caring
applied to both the therapist and the
client
• Recognize that each individual is both
unique and similar
• Empower the client to discover his or her
own path, no matter how painful
Different Levels of Relating
• At the social level, two strangers get to know
each other in a trusting and non-judgmental
environment
• At the existential level, two human beings share
their common humanity and their authentic
selves
• At the professional level, the therapist is
responsible for achieving desirable therapeutic
goals
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 his or her true
identity and place in the world
• To help the client pursue what really
matters in life
Therapeutic Goals (cont.)
• To develop the client’s full potential
• To make life better for self & others
• To transform a victim’s journey into a
hero’s adventure
• To discover meaning and hope in
boundary situations
• To transform negatives into positives
through meaning seeking/making
The Art of Questioning
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Responsibility questions
Choice questions
Trajectory questions
Quest questions
Magic questions
Diagnostic questions
Eight Enduring
Existential Questions
1. Who am I?
2. What do I want? What really matters in my life?
3. How and where can I find happiness?
4. What should I do with my life?
5. How can I avoid making the wrong choices?
6. Where do I belong? Where is my home?
7. What is the point of all my striving?
8. What will happen to me after I die?
Intervention Strategies
1. The PURE Strategy
2. The ABCDE Strategy
3. The Double Vision Strategy
4. The Dual Systems Strategy
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
• Accept and confront the reality – the reality principle
• Believe that life is worth living – the faith principle
• Commit to goals and actions – the action principle
• Discover the meaning and significance of self and
situations – the Aha! principle
• Evaluate the above – the self-regulation principle
Acceptance
• Accepting what cannot be changed
• Accepting reality, limitations, loss, trauma,
existential givens
• Acceptance does not mean giving up or
resignation
• Confronting one’s worst fears with courage and
tragic optimism
• Transcending and transforming the tragedy
Levels of Acceptance
• Cognitive acceptance
• Emotional acceptance
• Realistic acceptance
• Integrative acceptance
• Existential acceptance
• Transcendental acceptance
• Transformative acceptance
Belief
• Affirming one’s ideals and core values
• Believing in the intrinsic value and
meaning of life
• Believing in an Ultimate Rescuer or
Higher Power
• Believing in the eventual triumph of
good & 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
• Digging deeper, exploring farther, and searching
higher
• Discovering one’s hidden courage and strength
• Discovering the power of faith and spiritual
resources
• 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
The Double Vision Strategy
Meaning-mindset
Meaningful
moments
PURE Framework
Sources of
meaning
Frankl’s 3 basic
tenets and values
of meaning
Avoidance
Approach
A Dual-Systems Model of
Living the Good Life
Seeking what is meaningful
Enjoying the present moment
The
Good
Life
Transforming what is negative
Letting go
© Paul T. P. Wong
Aspects of Spirituality
• 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)
• Addressing patients’ spiritual needs
• Addressing patients’ existential needs
• Taking a spiritual history of patients
• Incorporating appropriate spiritual practices
• Involving chaplains and spiritual leaders
• Involving the appropriate faith community
A Transformative Approach to
Spiritual Care
(Based on what you say and do with patients)
• The healing silence – listening to the inner voice
• The healing touch – touching the heart & soul
• The healing connection – establishing an I-You
relationship
• The healing presence – providing a caring,
compassionate presence
• The healing process – nurturing spiritual growth
Current Trends in
Spirituality and Health
• Breaking down the barriers between the
medicine, psychotherapy, and religion
• The inadequacy of a technological, curebased medical model
• Increasing recognition of the role of
spirituality in health care
Current Trends (cont.)
• No medication for broken hearts or
wounded souls
• The need for compassionate care
(Puchalski, 2001)
• The need for spiritual care and spiritual
transformation
What is Compassionate Care?
• “Serving patients may involve spending time
with them, holding their hands, and talking
about what is important to them”
(Pychalski, 2001)
• “The word compassion means ‘to suffer
with.’ Compassionate care calls physicians
to walk with people in the midst of their
pain, to be partners with patients rather
than experts dictating information to them”
(Puchalski, 2001)
A Holistic Approach to
Health Care
• The person is dimensional and unified
• Wong’s schematic presentation
• Caring for physical, psychological,
existential, and spiritual needs
• Cure is not possible for many illnesses
• Healing is possible in all illnesses
• The core of healing is spiritual
Spirituality & Health
• Spiritual hunger: A universal human need
• The biological basis of spirituality
• Spiritual being vs. Spiritual awakening
• Spirituality vs. Religion
• Intrinsic vs. Extrinsic religion
• Part of the medical curriculum
The Role of Faith and Spirituality in Health
• Prayer contributes to healing and recovery
• Faith enhances quality of life, hope, and
happiness
• Religious beliefs affect medical decisions
• Spiritual beliefs facilitate death acceptance
• Coping with chronic pain, disability and terminal
illnesses
• Addressing existential issues
• Making it an integral part of holistic care
Empirical Findings on the Benefits of
Faith
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Greater longevity
Higher quality-of-life score
Lower blood pressure
Fewer cardiovascular problems
Fewer cases of depression & anxiety
Better immune functioning
Faster recovery from surgery
Healthy life style
Be a Spiritually Transformed Healer
• Understanding your own spiritual needs
• Nurturing your own spirituality
• Treating spirituality as part of personal &
professional development
• Caring for the wounded healer
• Viewing the world from a spiritual lens
• Transforming spiritual care into Divine care
Conclusion
• Meaning is a key component in spiritual
care for cancer patients.
• Meaning therapy is integrative. It focuses
on the human capacity for meaningseeking & meaning-making.