MEANING – THERAPY (a) Paul T. P. Wong, PhD, CPsych Meaning Conference 2012 Toronto

 Learning an integrative and innovative way to repair the worst and bring out the best.  Learn how to develop the meaning-mindset as the basis for personal transformation  Learn how to use the strategy of double vision in achieve optimal effective coping.  Learn how to use the PURE strategy to build a meaningful and rewarding future.  Learn the apply the basic ABCDE intervention strategy to a variety of problems. LEARNING OBJECTIVES

Why we need an integrative approach

THE MEANING MINDSET Success Failure Meaning Fulfillment Emptiness Ideal Life Wasted Life Shallow Life Sacrificial Life

1.I can find something meaningful or significant in everyday events. 2.There is a reason for everything that happens to me. 3.There is no ultimate meaning and purpose in life. 4.There is no point in searching for meaning in life. 5.No matter how painful the situation, life is still worth living. 6.The meaning of life is to “eat, drink and be happy.” 7.What really matters to me is to pursue a higher purpose or calling regardless of personal cost. 8.I would rather be a happy pig than a sad saint. 9.I am willing to sacrifice personal interests for the greater good. 10.Personal happiness and success are more important to me than achieving inner goodness and moral excellence. LIFE ORIENTATION SCALE

CHOOSING THE ROAD LESS TRAVELLED

 Life Orientation Scale (LOS; Wong, 2012)  Personal Meaning Profile-Brief (PMP-B; Wong, 2012)  The PURE Test (Wong, 2011)  Meaningful Living Scale (MLS; Wong, 2011)  Coping Schema Inventory – Revised (CSI-R; Wong, Reker, & Peacock, 2006) MEASUREMENTS OF MEANING & PURPOSE IN LIFE

 Meaning is all we have.  Relationship is all we need.  Effective therapy depends on making full use of our capacity for meaning making and relating. THE MOTTO OF MT

 It evolves from logotherapy and cognitive behavioral therapy.  It is part of the third wave of psychotherapy which involves powerful new concepts such as acceptance, commitment, self-transcendence, and meaning- making.  Viktor Frankl is the father of logotherapy. WHAT IS MEANING-THERAPY (MT)

 WHO IS VIKTOR FRANKL?

 Logotherapy literally means therapy through meaning.  It is a spiritually-oriented approach towards psychotherapy.  Existential analysis is needed to make the clients aware of their spirituality and capacity for meaning.  “Inasmuch as logotherapy makes him aware of the hidden logos of his existence, it is an analytical process” (Frankl, 1984, p. 125). WHAT IS LOGOTHERAPY?

 Freedom of will: Not only freedom from some negative condition but also freedom to something rewarding.  Will to meaning: Striving to find a meaning in one’s life is the primary motivational force.  Meaning of life: One can always discover meaning in life regardless of life’s circumstances. THE BASIC TENETS OF LOGOTHERAPY

 Creative value: giving something to the world through creative works.  Experiential value: receiving something from the world through appreciation and gratitude.  Attitudinal value: taking a heroic stand towards suffering and fate. THREE BASIC PATHWAYS TO MEANING

 Many people seek healing of inner emptiness because of a felt sense of existential vacuum.  Frankl believes that existential vacuum may lead to both the tragic triad and neurotic triad. Meaning therapy is uniquely suitable to address these mental health issues. EXISTENTIAL VACUUM

THE TRAGIC TRIAD death pain guilt

THE NEUROTIC TRIAD addiction depression aggression

 According to Irwin Yalom (1980), there are at least 4 universal existential anxieties: 1.Loneliness or alienation 2.Freedom of choice (basic ontological crisis) 3.Death anxiety 4.Meaninglessness (related to the above three)  Many psychiatric symptoms such as depression and anxiety are manifestations of the underlying existential anxieties. EXISTENTIAL ANXIETIES

 Integrative/holistic  Existential/spiritual  Relational  Positively oriented  Multicultural  Narrative  Psycho-educational THE DEFINING CHARACTERISTICS OF MT

Carl Rogers’ 3 pre-conditions for effective counselling. 1.Empathy 2.Unconditional positive regard (non- judgmental) 3.Congruence or genuineness [ LAYING THE GROUNDWORK FOR POSITIVE CHANGE

 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. THE THERAPEUTIC PRESENCE

 Building rapport and trust is essential to effective therapy.  Authentic and caring relationships has more healing power than therapeutic alliance.  Accepting resistance and negative reaction as part of the healing process.  The ground rule of respect and caring applied to both the therapist and the client.  Recognize that each individual is both unique and similar. HEALING THROUGH RELATIONSHIP

 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.  At the professional level, the therapist is responsible for achieving desirable therapeutic goals.  Therapy involves the reciprocal influence between the therapist and the client. DIFFERENT LEVELS OF RELATING

1.Listening with one’s ears 2.Listening with one’s eyes 3.Listening to one’s cultural voice 4.Listening with one’s head 5.Listening with one’s heart 6.Listening with one’s soul 7.Listening to the spirit LEVELS OF LISTENING

 Confusing fact with fiction  Confusing emotion with intention  Confusing past with present  Biases and assumptions  Lack of empathy and sympathy  Lack of attention and focus  Delayed emotional explosion  Making dispositional attributions  Different styles of communication  Different levels of listening BARRIERS TO CLEAR COMMUNICATION

 To awaken the client’s awareness of personal responsibility and meaning in life.  To achieve a deeper understanding of the problem from a larger perspective.  To help the client discover their true identify and place in the world.  To help the client pursue what really matters in life. THERAPEUTIC GOALS

 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. THERAPEUTIC GOALS CONT’D

 Cultivating a healing presence.  Creating a safe and trusting environment.  Explaining to clients the MT approach.  Listening proactively to discover the nature of presenting problems and unspoken needs.  Agreeing on the priority of issues to be addressed.  Developing a concrete plan for actions.  Emphasizing the demand for responsibility and restoration of meaning and purpose. THERAPEUTIC PLAN

 Responsibility questions  Choice questions  Trajectory questions  Quest questions  Eight enduring existential questions  Magic questions  Diagnostic questions THE ART OF QUESTIONING

1.Who am I? 2.How and where do I find happiness? 3.What should I do with my life? 4.How can I avoid making the wrong choices in the major areas of my life? 5.Where do I belong? 6.What is the point of all my striving? 7.What will happen to me after I die? 8.What would make my life more meaningful and significant? EIGHT ENDURING EXISTENTIAL QUESTIONS

Part 1: The Double Vision Strategy and the PURE Principles MEANING-CENTERED INTERVENTIONS

 Try to identify the underlying existential anxiety for each presenting problem.  Solution-focused therapy needs to consider both the immediate problem and the larger personal issue.  Short-term goals need to be related to larger life goals.  Do not focus on the leaves and ignore the forest.  Keep one eye on the ball and another eye on the goal. DOUBLE VISION

 Micro-skills refer to interventions that target specific situational problems.  Attribution retraining  Cognitive reframing  Macro-skills refer to interventions that target larger societal, ecological, cultural, and existential problems  Advocating for social change and community reform.  Identifying the macro-forces that contribute to one’s problems. MICRO VS. MACRO SKILLS

The four treasures of MT:  Purpose – the motivational component  Understanding – the cognitive component  Responsible action – the behavioral component  Evaluation – the affective component THE PURE PRINCIPLES

 Including goals, directions, incentive objects, core values, aspirations and intentions.  What do I want to get from this situation? What should I do with my life? What really matters in life?  Deciding on one’s ultimate concern: The happiness- mindset vs. the meaning-mindset (Wong, 2011).  Beware of the pitfalls of the pursuit of happiness. PURPOSE

 Encompassing self-understanding, a sense of coherence, making sense of situations and other people.  Having a clear sense of who one is, what one is and what one’s place in the world is.  Don’t be a stranger to oneself – dare to open the dark rooms and secret chambers in one’s life.  Knowing another person’s true intention and feelings thru effective communication  Having the practical wisdom to make sound judgments and good decisions. UNDERSTANDING

 Freedom and responsibility go hand in hand.  Doing the right thing and finding the right solution.  Choosing appropriate reactions and actions in situations of conflicting values and demands.  Holding oneself accountable for one’s own behavior.  Discovering to what extent one is responsible for a given problem. Blaming only makes things worse.  Take ownership of one’s life and assume full responsibility for building a preferred future. RESPONSIBILITY

 Assessing degree of satisfaction with the situation or life as a whole  Living a life of purpose, understanding and responsibility does not always guarantee happiness.  Have I achieved what I set out to do?  Am I happy with how I have lived my life?  If this is love, why am I still unhappy?  Self-regulation depends on self-reflection and evaluation. ENJOYMENT/EVALUATION

According to Wong (1998), there are 8 sources of meaning and the good life. 1.Achievement 2.Acceptance 3.Transcendence 4.Intimacy 5.Relationship 6.Religion 7.Fairness 8.Positive emotions SOURCES OF MEANING

A MEANINGFUL LIFE IS A BALANCED ONE Religion/ Spirituality Situational and Cultural Context AchievementAcceptance Self-transcendence Intimacy Relationship Fairness Healing and Flourishing

1.It is deeply felt – It touches your emotions in a deep and lasting way. More than a fleeting feeling, it reaches your inner most 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. DEFINITION OF A MEANINGFUL MOMENT

Meaning-mindset (Overall Orientation) Meaningful moments (Experiences) PURE Framework (Structure) Sources of meaning (Content) Frankl’s 3 basic tenets and values of meaning (Foundation)

Part 2: ABCDE Model of Resilience Tragic Optimism The Dual- Systems Model MEANING-CENTERED INTERVENTIONS

 The best built house can be destroyed.  No one is immune from suffering and tragedies.  Bad things do happen to good people.  There is a breaking point for everyone.  The challenge is to recover and become stronger. WHEN TRAGEDY STRIKES

FOUR LIFE TRAJECTORIES

 Recovery: Bouncing back and returning to normal functioning.  Invulnerability: Remaining relatively unscathed by the adversity or trauma.  Post-traumatic Growth: Bouncing back and becoming stronger. PATTERNS OF RESILIENCE

 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. ABCDE STRATEGY

 Accepting what cannot be changed.  Accepting reality, limitations, loss, trauma, existential givens.  Acceptance does not mean giving up or resignation.  Confronting one’s worse fears with courage and tragic optimism.  Transcending and transforming the tragedy. ACCEPTANCE

THE COURAGE OF SELF-ACCEPTANCE

 Cognitive acceptance  Emotional acceptance  Realistic acceptance  Integrative acceptance  Existential acceptance  Transcendental acceptance  Transformative acceptance LEVELS OF ACCEPTANCE

Affirming one’s ideals and core values.  Recognizing the intrinsic value and meaning of life.  Receiving support and help from others.  Turning to a personal God or higher power.  Growing and striving for positive transformation.  Believing in an eventual triumph of good over evil.  Recognizing the worthwhileness and authenticity of one’s mission.  Recognizing and using one’s competencies, character strengths and virtues. BELIEF

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 your cause.  Problem-solving and effective coping.  Avoiding errors and temptations.  Practicing the PURE principle.  Pursuing realistic goals.  Re-authoring one’s life story. COMMITMENT

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. DISCOVERY

Savoring small successes or re-assessing one’s progress.  Feeling relief that the worse is over.  Monitoring progress.  Savoring the moments of small success.  Reflecting and reviewing one’s life.  Receiving feedback from others.  Conducting assessments and making adjustments. EVALUATION

 Acceptance of the worst.  Affirmation in the value and meaning of life.  Self-transcendence (altruism).  Faith in God and others.  Courage to face adversity. ELEMENTS OF TRAGIC OPTIMISM

DUAL-SYSTEMS MODEL  We can best achieve adaptive success through integrating approach and avoidance systems.  The approach system – life expansion  The avoidance system – life protection  Employ offence and defence at the same time.

A Dual-Systems Model Individual differences and personal resources Positive Conditions Negative Conditions Positive Outcome Negative Outcome Approach Avoidance PURE ABCDE Cultural and Contextual Variables

 We instinctively approach what is perceived as appetitive, and avoid what is perceived as aversive or noxious.  The approach and avoidance systems involve different emotional-behavioral processes and neuro- physiological substrates. INTERACTIONS BETWEEN THE TWO SYSTEMS

 The positive system seeks to do what is desirable and preferable.  The aversive system serves as a warning about what is wrong in one’s life and what is potentially threatening.  There is a downside to positives and upside to negatives. INTERACTIONS BETWEEN THE TWO SYSTEMS (CONT’D)

 Together, these two self-regulation systems provide a road map to make life worth living through good and bad times.  Meaning management helps integrate both negative and positive systems. INTERACTIONS BETWEEN THE TWO SYSTEMS (CONT’D)

ABCDE PURE Approach Tragic Optimism Avoidance POSITIVE TRIAD OF HEALING AND FLOURISHING

Experience of Positive Emotions (Factor I) Deep-and-Wide Theory of Effective Coping (Factor III) Reduced Negativity & Increased Resourcefulness Broaden-and-Build Model of Positive Emotions Personal Growth, Character Strengths, & the PURE Model (Factor II) Complete Mental Health and Flourishing Sources of Meaning MEANING-BASED MODEL OF WELL-BEING AND MENTAL HEALTH