User:Evelyn Mak/sandbox/Meaning therapy

Meaning therapy (MT) is a pluralistic approach to counselling and therapy that focuses on the fundamental human needs for meaning and relationship. It is a comprehensive way to address all aspects of meaning in life concerns in a supportive therapeutic relationship. Thus, the motto for MT is: Meaning is all we have; relationship is all we need. MT assumes that when these two essential human needs are met, individuals are more likely to cope better with their predicaments and live a more rewarding life; when there is a deficiency in these two areas, people will more likely experience difficulties in life.

MT favours a psychoeducational approach that recognizes the vital role of meaning and purpose in healing and well-being. It appeals to the client’s sense of responsibility to make full use of their freedom to pursue what really matters and what constitutes a rewarding future. Within this conceptual framework, the therapist provides a safe and trusting environment that facilitates collaborative effort and shared decision making in terms of preferred interventions, plans, and goals.

Background
In the 1930s, Dr. Viktor Frankl developed logotherapy, which literally means “healing through meaning.” It was widely known as the Third Viennese School of Psychotherapy, in addition to Freud’s psychoanalysis and Adler’s individual psychology. Logotherapy became popularized with Frankl’s publication of Man’s Search for Meaning, which has sold more than 30 million copies worldwide.

Logotherapy was introduced to North America by Dr. Joseph Fabry, founder of the Viktor Frankl Institute of Logotherapy in the United States and established The International Forum for Logotherapy. Dr. Paul Wong first developed MT by integrating logotherapy with cognitive behavioral therapy, which was published in the forum. He then extended the integration to humanistic-existential therapy and positive psychotherapy. Further developments of MT were published subsequently (see section on Selected Publications).

Meaning-centered
Human beings are the only meaning-seeking and meaning-making species. Everything about people is related to meaning—how we think, how we see ourselves, how we attribute meaning to different life situations, and how we construct stories about our own lives and others. The language we speak and the cultural values we hold are also aspects of our meaning systems. Our anxieties about the fragility of life and our own mortality stem from our unique capacity for meaning.

Apart from inevitable existential anxieties, our suffering and distress in daily life come from misattribution, negative appraisal, dysfunctioning beliefs, and misplaced values more than from actual life events. When people pursue money, power, and fame to satisfy their need for meaning and significance, such misguided ambitions are self-defeating and become the source of suffering. People need to examine their values and discover which goal-strivings really endow their lives with enduring meaning and significance. In view of the above, MT emphasizes that meaning is all we need in counselling and psychotherapy, if we want to help clients better understand themselves, their predicaments, and their place in the world, and cope more adaptively with the demands of life.

Relationship-oriented
Research has shown that relationships are essential for happiness and meaning as well as the importance of social support in buffering against stress and maintaining mental health. In sum, a strong network of social support is essential for mental health and meaningful living.

According to research, a good relationship with clients is one of the most important common factors in effective psychotherapy. MT goes beyond therapeutic alliance and emphasizes an authentic relationship, one which shows a therapist’s genuine care and empathy for his/her clients and belief in their potentials to overcome. Thus, MT begins with the therapeutic presence of the therapist. The therapist is the therapy because of the curative benefits of the therapist’s personal qualities of unconditional positive regard, empathy, and genuineness. Furthermore, the entire counselling process—the moment-to-moment fluid and dynamic interactions between the therapist and client—provides many opportunities for genuine encounters and timely intervention. Through such authentic encounters, clients learn how to develop new patterns of relating in a more adaptive and rewarding manner.

Evidence-based
The theoretical concepts and interventions of MT are supported by mounting empirical evidence of the vital role of meaning in human experience and well-being. Meta-analyses of existential therapies also support the central role of meaning. Research supporting cognitive-behavioral therapy and acceptance and commitment therapy also provides support for MT.

There is also ample empirical support for the pluralistic approach to counselling and therapy. In addition, there is also increasing empirical support for the transdiagnostic approach in focusing on the underlying drivers (e.g., the lack of meaning and relationship) for psychological problems.

Interventions
MT interventions are also referred to as existential positive interventions. Most of the intervention strategies and skills can be found in Wong's 2016 and 2012 chapters. Given its psycho-educational orientation, MT aims to equip clients with the necessary tools to cope with the demands of life in a way that contributes to both healing and growth.

Meaning-centered interventions can be grouped into four main categories:
 * 1) Cognitive meaning interventions: Attribution-retraining, re-appraisal or meaning-focused coping, and challenging dysfunctional thinking, self-affirmation of core values and beliefs, etc.
 * 2) Existential meaning interventions: Cultivating sources of meaning, tragic optimism, the PURE strategy (Purpose, Understanding, Responsibility, and Enjoyment),   etc.
 * 3) Effective coping: Resource-congruence model of coping, existential coping (acceptance and benefit seeking ), and religious coping.
 * 4) Relational training: Active listening, authentic encounters, forgiveness, gratitude, shared activities and goals, and mutuality.

Differences
The main difference between MT and Frankl’s logotherapy is that MT is more integrative and inclusive. MT is also different from other recent developments in meaning-oriented approach, such as Dr. Wiliam Breitbart’s meaning-centered therapy for cancer patients and Dr. Marie Dezelic’s meaning-centered therapy, as the latter two are almost completely based on logotherapy.

The biggest difference between MT and other meaning-oriented approaches is that MT incorporates the humanistic perspective of treating clients as fellow human beings worthy of dignity and respect and believing in their potential for healing and personal growth. Meaning-oriented therapists do not treat clients as simply clinical cases with problems to be fixed. Although MT makes use of psychoeducation to teach clients the vital role of meaning in well-being, its overall approach is a person-centered one.

Advantages

 * 1) Given the holistic, multi-faceted nature of meaning, MT is inherently pluralistic. Therapy is flexible enough to be tailored to each individual client’s needs and preferences.
 * 2) MT is uniquely designed to deal with any kind of meaning crisis—whether it is death anxiety or a traumatic experience—that threatens one’s sense of meaning. MT capitalizes on the uniquely human capacity for meaning-seeking and meaning-making as the innate potential for healing and flourishing; it believes that meaning makes suffering more bearable regardless of how hopeless and terrible the circumstances.
 * 3) MT is inherently positive. It emphasizes a client’s innate capacity for positive change and potential to become a fully functioning person. However, MT also emphasizes that this growth process necessarily entails the need to overcome challenges and obstacles. In addition, MT holds a very high view of life. It affirms that every life has intrinsic meaning and value, and every person has the potential of making a useful contribution to society. It helps to restore a healthy sense of the true self as the foundation for healing and transformation. It focuses on being and becoming through doing.
 * 4) MT emphasizes the human capacity for self-awareness of the human condition, and the basic human needs for freedom and responsibility, self-determination, and self-transcendence. Most MT interventions make use of people’s innate capacity for meaning seeking and meaning making.
 * 5) Consistent with second wave positive psychology,  MT aims at repairing the worst and bringing out the best in people, regardless of their conditions and circumstances. Meaning-based interventions serve the dual purpose of alleviating suffering and enhancing well-being at the same time.

Criticism
Most of the common criticisms directed to humanistic-existential therapy are applicable to MT. One obvious limitation of MT is that it cannot be effectively applied to individuals who have limited cognitive capacities or vocabulary to address meaning in life issues. Another critique is that since it is client-centered and relationship-oriented and focuses on the dynamic and fluid therapeutic process, it lacks clearly specified intervention protocols.

Moreover, existentially oriented therapies are designed to affect people at a deeper level; therefore, the outcome cannot be easily measured or quantified in terms of evaluation.

Selected publications

 * 1) Wong, P. T. P. (2016). Integrative meaning therapy: From logotherapy to existential positive interventions. In P. Russo-Netzer, S. E. Schulenberg, & A. Batthyany (Eds.). To thrive, to cope, to understand: Meaning in positive and existential psychotherapy (pp. 0–0). New York, NY: Springer.
 * 2) Wong, P. T. P. (2015). Meaning therapy: Assessments and interventions. Existential Analysis, 26(1), 154-167.
 * 3) Wong, P. T. P. (2012). From logotherapy to meaning-centered counseling and therapy. In P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications (2nd ed., pp. 619–647). New York, NY: Routledge.
 * 4) Wong, P. T. P. (2008). Meaning management theory and death acceptance. In A. Tomer, G. T. Eliason, & P. T. P. Wong (Eds.), Existential and spiritual issues in death attitudes (pp. 65–87). New York, NY: Erlbaum.
 * 5) Wong, P. T. P. (2005). Existential and humanistic theories. In J. C. Thomas, & D. L. Segal (Eds.), Comprehensive handbook of personality and psychopathology (pp. 192–211). Hoboken, NJ: Wiley.