1. Meaning and the therapeutic relationship
Prof. dr. Siebrecht Vanhooren

2. Meaning and the therapeutic relationship
There is a robust relationship between meaning in life and psychological health and well-being (Steger, 2012)
The therapeutic relationship is a pre-condition of the construction and experience of new meaning, and therapy is a meaning-making process as such (Angus & Greenberg, 2011)
The therapeutic relationship – and especially empathy – is the most robust predictor of psychotherapy outcome (Norcross & Lambert, 2018; Wampold, 2015).
Enough reasons to have a look how meaning, the therapeutic relationship and outcome are related

3. Three studies

4. Clients in this study
Therapists: person-centered & experiential psychotherapists in training (Postgraduate program, KU Leuven, Belgium)
Naturalistic setting: outpatients (private practices, outpatient clinics, mental health centers), with depression, anxiety, personality disorders

5. Measures Meaning in life Questionnaire (MLQ; Steger et al. 2006)
Presence of meaning
Search for meaning
Outcome Questionnaire 45 (OQ-45)
Working alliance inventory (WAI; Horvath & Greenberg, 1982; Dutch translation Werk alliantie vragenlijst, WAV-12 (Stinckens, Ulburghs, & Claes, 2009)
Bond
Goal
Task

6. Studies Study 1: meaning at the start of psychotherapy. N=145
Golovchanova, Dezutter, & Vanhooren; submitted
Study 2: meaning in life as a mediator between the therapeutic relationship
N=96
Fortems, 2019
Study 3: Four mixed-method case studies
Vandebeek, 2019

7. Study 1: Meaning profiles at the start of therapy
Golovchanova, Dezutter, & Vanhooren; Submitted

8. Meaning and the therapeutic relationship at the start of psychotherapy
Outpatient Clients (N=145) (Golovchanova, Dezutter, & Vanhooren; submitted)
Therapy clients
Students
Adults
Current study
Hill et al., 2017
Steger et al., 2006
Park et al., 2010
Mean SD
Presence of Meaning
20.84
6.30
20.28
3.90
24.80
6.50
25.10
7.80
Search for Meaning
23.04
6.51
25.58
4.42
24.50
8.20
24.10
8.30
Table 1.
Comparison of presence of meaning and search for meaning average scores in various populations

9. Preliminary analyses Correlations between age and study variables 1 21 2 3 4 5 6 7 8 9 10
1. Age
2.Presence of Meaning
.058
3.Search for Meaning
-.137
-.407**
4.Task
-.094
.295**
-.043
5.Goal
-.085
.245**
-.105
.732**
6.Bond
-.204*
.255**
-.083
.576**
.586**
7.Total Symptomatology
.008
-.607**
.358**
-.059
-.093
-.120
8.Symptom Distress
-.064
-.583**
.327**
-.032
-.049
-.035
.941**
9.Interpersonal Relations
.163
-.353**
.271**
-.048
-.148
-.242**
.662**
.434**
10.Social Role
.032
-.465**
.247**
-.104
-.079
-.128
.725**
.563**
.379**
Correlations between age and study variables
Note: Listwise N=114
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).

10. Meaning profiles at the start of psychotherapy
Clients (N=145) (Golovchanova, Dezutter, & Vanhooren; submitted)
Differences between profiles on distress, not on appraisal of the therapeutic relationship

11. Study 2: Meaning in life mediates between therapeutic relationship and distress
Fortems, 2019

12. Session 5 (N=96) (Fortems, 2019)
Table 1
Descriptive statistics of the study variables (n = 96)
Mean SD
Minimum
Maximum
Therapeutic alliance (WAV-12)
44.53
7.401 24 60
Presence of meaning (MLQ-P)
20.87
6.706 5 35
Psychological distress (OQ-45)
74.04
22.369 12
140
Total OQ score of 55 or higher is considered clinically significant (de Jong et al., 2007).

13. Session 5 (N= 96) (Fortems, 2019)
Table 2
Pearson correlations among age, therapeutic alliance, meaning in life and psychological distress
Age
Therapeutic alliance
Meaning in life
Psychological distress —
Therapeutic alliance
-.084
.063
.234*
Psychological distress
-.016
-.251*
-.371**
* Correlation is significant at the .05 level (2-tailed).
** Correlation is significant at the .01 level (2-tailed).

14. Session 5 (N= 96) (Fortems, 2019)

15. Mediation analysis (therapeutic alliance)

16. Mediation analysis (bond)

17. Study 3: Mixed-method case studies
Vandebeek, 2019

18. Client ‘Charlotte’ (Vandebeek, 2019)
47 years, married with children
23 sessions
Eating disorder, depression
Measures
MLQ
OQ-45
WAI (WAV-12)
HAT (Helpful Aspects in Therapy: SBL)
Significant changes: Leeds Relyable Change Index (RCI)

19. Presence & search for meaning

20. Presence of meaning

21. Distress

22. Therapeutic relationship (bond)

23. Therapeutic relationship: bond and goals

24. So… Meaning in life significantly drops
Therapeutic bond significantly increases
Negative relationship therapeutic bond and presence of meaning!?!
Level of distress doesn’t change

25. Content therapy
Charlotte reports small new insights in the first sessions
Session 5: insight in the causes of my eating disorder
Session 6: about meaning in life, but arrives at a deep fear (angst)
Session 7: About angst, freedom, and responibility
Session 9 & 10: experiencing a deep need to come to herself

26. Presence & search for meaning

27. Content Session 12: meaning in life
Session 13: ‘existential depression’ as the real cause of her unhappiness
Session 14: exploring a pinched feeling inside (felt sense)
Session 15: new insights and seeing new connections, and as a result feeling the neccessity to make some hard decisions. Experiencing anger because she does not feel seen at home and at work.

28. Presence & search for meaning

29. Content therapy
Sessions 16-18: more emotional awareness; allowing feelings as important steps (It is confronting that I een cannot allow positive feelings)
Session 19: quit job
Session 21: the need to say to her partner was is important to her. Unmet needs in the relationship. The emotional burden of taking care of the children.
Further evolution…?

30. Meting van
 Session 2 4 6 10 12 14 18 20 22
Therapist involvement, feeling supported & confirmed 5 7 8
Openness & genuiness
Empathy & understanding
Exploration
Confrontation, feedback & advise
Positive feelings & experience of progress
Insights & new perspectives
Relationship with the therapist
I belief that my problems will be changed through therapy
I expect that I will feel better through therapy
I hope that the therapy will be succesful
Cijfermatige feedback van Charlotte uit de SBL+
Opmerking: scoring tussen 0 en 10

31. Early conclusions? Hm…
A lot of questions

32. Concluding questions
There seems to be a relationship between the therapeutic relationship and meaning in life. However…
It is an intricate one
The therapeutic relationship can be
A pre-condition for change in meaning (Angus & Greenberg, 2011; Rogers, 1957, 1980)

33. The therapeutic relationship (bond) can be…
A pre-condition for change in meaning (Angus & Greenberg, 2011; Rogers, 1957, 1980)
Safe space to explore issues
Can initially cause a loss of meaning
And become fully aware of a lack of meaning

34. The therapeutic relationship (bond) can be…
A pre-condition for change in meaning (Angus & Greenberg, 2011; Rogers, 1957, 1980)
A place where skills are learned in order to create/find meaning, make sense of one’s life
Empathy and its influence on emotion-regulation and attachment
A place to find/create meaning and make sense
Empathy, reflection, integration
New meaning

35. The therapeutic relationship (bond) can be…
An interpersonal connecting place where meaning in life itself is sensed
The clients matters to the therapist
The experience of therapy makes the client’s life feel more meaningful
The client feels hope through the therapeutic relationship to develop deeper relationships with other people as well

36. The therapeutic relationship (bond) can be…
Facilitated by the initial meaning in life of the client
The client’s general sense of connection and ease to make connection

37. Future studies should focus on…
The change in meaning in life in long term therapies
The interplay between Meaning, Relationship, and Outcome are part of a proces of change…
The role of perceived empathy in meaning-making, depth of experiencing, emotion-regulation
Use different measures for meaning
MLQ: too unidimensional?
Sources of meaning
Aspects of meaning

38. Prof. dr. Siebrecht Vanhooren KU Leuven Faculty of Psychology and Educational Sciences Research group Clinical Psychology Tiensestraat Leuven Belgium