Clinical Perspectives on Meaning: Positive and Existential Psychotherapy

Clinical Perspectives on Meaning: Positive and Existential Psychotherapy by Stefan E. Schulenberg (28 Jan. 2017, 454 Pages)

This unique theory-to-practice volume presents far-reaching advances in positive and existential therapy, with emphasis on meaning-making as central to coping and resilience, growth and positive change. Innovative meaning-based strategies are presented with clients facing medical and mental health challenges such as spinal cord injury, depression, and cancer.

Nous avons en particulier remarqué l’article « Working with Meaning in Life in Mental Health Care: A Systematic Literature Review of the Practices and Effectiveness of Meaning-Centred Therapies » de Joel Vos, ainsi que son autre article « Working with Meaning in Life in Chronic or Life-Threatening Disease: A Review of Its Relevance and the Effectiveness of Meaning-Centred Therapies »

Overview of life domains and hypothetical underlying values

as identified in a systematic literature review of 79 publications on what individuals’ experience as meaningful in life and categorised via thematic analyses (Vos, 2016a) p.70

I. Materialistic–hedonic domain of meaning

Underlying value: the value of having material goods, objective success, nice physical experiences
(a) Material conditions
E.g. finances, housing, possessions, practical daily life activities
(b) Professional and educational success
E.g. general success, professional success, educational success, profession/education-related social status
(c) Hedonic and experiential activities
E.g. hedonism, leisure and joyful activities, peak experiences, sex, nature and animals
(d) Health
E.g. Being healthy, healthy lifestyle, sports

II. Self-oriented sources of meaning

Underlying value: the value of the self
(a) Resilience (coping successfully with difficult life situations)
E.g. flexibility, perseverance and hardiness, accepting challenges, effective coping skills
(b) Self-efficacy
E.g. feeling in control, knowing how to set, experiment and adjust reachable goals in daily life
(c) Self-acceptance
E.g. self-insight, self-acceptance, self-esteem
(d) Creative self-expression
E.g. in work or hobby, such as making music, writing, sports and having a creative dynamic lifestyle
(e) Autonomy
E.g. self-reliance, non-selfish balance with social context
(f) Self-care

III. Social sources of meaning

Underlying value: the value of being connected with others, belonging to a specific community and improving the well-being of others and children in particular
(a) Feeling socially connected
E.g. sociability, friends, family, intimate relationships
(b) Belonging to a specific community
E.g. family, community, history and society
(c) Altruism
E.g. selfless services to others, contribution to society
(d) Taking care of children
E.g. becoming a parent, foster care, working in education

IV. Transcending/higher sources of meaning

Underlying value: values about something larger than their materialistic–hedonic experiences, themselves and other human beings, merely for the sake of that larger value
(a) Purposes
E.g. specific higher purposes, goals or aims in life
(b) Personal growth
E.g. self-development (e.g. cognitive, behavioural self-developnment via education, training and therapy), self-transcendence, self-realisation and realising one’s highest personal potential consistent
(c) Temporality
E.g. future-oriented, sense of coherence and feeling part of the totality of past, present, future, legacy and after-life
(d) Justice & ethics
E.g. following ethical standards, being treated in a just way, contributing to a just world
(e) Spirituality & religion
E.g. spirituality and religion, beliefs, cosmic meaning, peace harmony and balance

V. The meaning of being here (‘meta-meaning’)

Underlying value: the value of being able to have values and the meaning of being able to experience meanings. Thus, this source of meaning does not have a specific content like the other types of meaning but is more abstract, philosophical or spiritual; the mere fact that someone is breathing and is able to make unique decisions within freedom is a gift to which one may feel grateful and may want to respond to with responsible decisions. This type of meaning can be implicitly present and underlying the other types of meaning.

(a) Being alive: e.g. being born, feeling alive, being until death
(b) Uniqueness: e.g. the unique individuality of one’s own experiences, own life, own world and own self
(c) Connectedness with the world and others: e.g. being in the world, being in context, being in relationships
(d) Individual freedom: e.g. freedom of decision, freedom to decide one’s attitude towards a limitation situation in life, the possibility to leave a legacy
(e) Be grateful to life as a gift: e.g. experiencing the mere fact of being born as a gift or miracle that one did not ask for but one regards as highly precious and special and to which one responds with gratitude
(f) Responsibility: e.g. the individual responsibility for oneself to live a meaningful life according to one’s highest values

Overview of therapeutic skills

identified via thematic analyses of the studies in a systematic literature review of therapies explicitly and systematically addressing meaning in life
(Vos & Vitali, 2016), p72.

PART I. Assessment skills

1. Exploring the client’s request for support in a non-reductionist and multidimensional way
2. Assessing the immediate needs and life situation of the client
3. Developing a meaning-oriented case formulation
4. Making shared decisions about goals and method of the meaning-oriented practice
5. Using assessment as the start of the therapeutic process

Part II. Meaning-specific skills

6. Providing didactics about meaning in life
7. Focusing on long-term meaning in life instead of on short-term gratification and pleasures and showing the potential benefits of this focus
8. Identifying and explicating meaning-oriented topics in the experiences of the clients
9. Offering clients a guided discovery of their meaning potential via concrete exercises
10. Showing an unconditional positive regard about the possibility to find meaning in any situation in life
11. Addressing the totality of possible meanings in the client’s life, that is:

(a) Exploring multiple potential domains and underlying values how meaning can be experienced in life (e.g. Frankl: experiencing, attitude, productivity and creativity; according to Table 1, materialistic–hedonic, self-oriented, social, transcendent and meta-values)
(b) Experienced in multiple senses (affects, cognitions, behavioural, body)
(c) In different domains in life (work, social, political, etc.)
(d) Internal (e.g. inner attitude) and external (e.g. behaviour)
(e) Hedonic (e.g. pleasure in the here and now) and self-transcending (e.g. social and commitment to a purpose larger than the self, cosmic meaning)
(f) Conscious/explicit and unconscious/implicit meanings
(g) Balancing stress-causing meaning (e.g. positive aspects of stress and striving towards goals) and leisure time (e.g. relaxing after striving and working hard towards goals)
(h) Concrete meanings in daily life (e.g. behaviour and concrete decisions) and abstract meaning (e.g. ideals and values)
(i) Striving towards goals (i.e. linear, goal-directed, future-oriented) and non-goal-directed (i.e. non-linear, e.g. inner attitude and experiencing in the here and now)
(j) Deepening the experiences of these meanings

12. Concretising and specifying meaning in daily life
13. Stimulating effective goal management:

(a) help clients to set concrete aims for daily life,
(b) make a plan,

(c) experiment in daily life,

(d) evaluate these experiments,

(e) adjust the aims and methods and

(f) make long-term commitment to goals

14. Exploring meanings in the client’s past, as a potential source for improving self-esteem, hope and inspiration for future meaning
15. Stimulating the client to give his/her own independent-but-connected answer to his/her social context: encouraging the client to develop autonomy and stay connected with his/her social context at the same time (i.e. a ‘two-sided approach’ or ‘multiple partiality’).
16. Focusing on meanings that are based on and that stimulate self-esteem, self-love, self-efficacy and worthiness of the self

Part III. Existential skills: explicitly embedding meaning in the broader context of life

17. Recognising and explicitly addressing the existential dimension of the experiences of the client (e.g., the limitations of meaning in life and inevitable mortality)

18. Stimulating meaning-oriented coping with situations of suffering
19. Exploring paradoxical feelings about meaning in life and fostering acceptance of paradoxes and tensions
20. Identifying avoidance and denial of meaning-related topics, exploring the reasons of avoidance and denial and trying to overcome this
21. Stimulating the client to connect with the bigger temporal picture of past–present–future
22. Stimulating the client to take up his/her own responsibility for living a meaningful life
23. Phenomenologically exploring whether there are any hierarchies in the client’s experiences of meaning (e.g., in which experiences are more meaningful than others, how authentic are
certain meanings)

Part IV. Relational–humanistic skills: focus on the therapeutic relationship and on a phenomenological exploration of the client’s experiences

24. Using general skills to focus on improving and deepening the therapeutic relationship
25. Phenomenological exploration of the experiences of the client
26. Following the tempo of progress of the client
27. Empathising with the client’s struggles in life and stressing that existential struggles are common to all human beings
28. Tailoring the practice to the needs, skills and wishes of the client
30. Exploring which meanings the client expresses in the relationship with the practitioner
31. Helping the client to develop ethical and authentic relationships with others
32. Having an ethical stance towards the client and his/her situation

Part V. Spiritual and mindfulness skills: openness to the spiritual–cultural context, focus on acceptance, including experiential exercises (e.g., mindfulness)

33. Being sensitive to the religious and cultural context of the client
34. Stimulating de-reflection and self-distancing
35. Using experiential exercises focusing on inner awareness (e.g., mindfulness)
36. Stimulating a basic attitude of acceptance on multiple levels:

(a) Acceptance that specific life events have occurred (emotional acceptance and integrative acceptance which incorporates a negative event with positive aspects of life)
(b) Acceptance that absolute certainty about what is meaningful for ourselves (absolute existential meaning), about the meaning of the universe (absolute cosmic meaning) and how my life fits into this cosmic ‘big plan’ (e.g. ‘why did this happen to me?’) may not be achievable
(c) Acceptance of the world (e.g. accept physical limitation such as a disease)
(d) Acceptance of life (e.g. accept own experiences)
(e) Acceptance of self (e.g. accept and show who they are)
(f) Acceptance of what they experience as meaningful

37. Using nonintellectual therapeutic techniques (e.g. art, drama)
38. Exploring how the client subjectively experiences ‘cosmic meaning in life’, that is, ‘how everything fits into an overall coherent pattern such as the universe or a master plan’

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