1. Logotherapy, Meaning Therapy, & Spirituality
18TH ANNUAL CONFERENCE OF JAPANESE ASSOCIATION OF CLINICAL THANATOLOGY
Logotherapy, Meaning Therapy, & Spirituality
©Paul T. P. Wong

2. Overview The role of meaning in spiritual care for cancer patients
Dr. Frankl’s Logotherapy & his concept of spirituality
Wong’s Meaning Therapy in tapping into the human capacity for meaning making

3. Breitbart’s Meaning-Centered Group Therapy for Cancer Patients
Session 1 – Concepts of meaning and sources of meaning
Session 2 – Cancer and meaning
Session 3 – Meaning and historical context of life
Session 4 – Storytelling, life project
Session 5 – Limitations and finiteness of life
Session 6 – Responsibility, creativity, deeds
Session 7 – Experience, nature, art, humor
Session 8 – Termination, goodbyes, hopes for the future
Breitbart, W. (2001). Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer, Supportive Care in Cancer, DOI /s

4. Itami’s Meaningful Living Therapy with Cancer Patients
Reynolds (1989) - The basic principles for the patient of M.L.T. are:
To take major responsibility in the fight against the disease.
To live a life devoted to fulfilling daily goals.
To be helpful to others.
To undergo training in coping with the anxiety associated with illness and the fear of death.
To contend with death naturally and constructively by accepting the principle that everyone inevitably dies.
To avoid being a "sick person" even though ill.
To live out the remainder of life positively, undefeated by the disease.
Reynolds (1989):
“The theory of Meaningful Life Therapy holds that it is in control over our behavior that hope lies. In spite of our fears, in spite of our personality traits, we can take responsibility for what we do in the time remaining to us. The terminally ill patient is encouraged to behave in ways that turn focus away from ruminations, toward achieving purposes, observing and participating in external reality, and being useful to others. In the doing of constructive activities a kind of life purpose is discovered.”
Reynolds, D. K. (1989). Meaningful Life Therapy. Culture, Medicine and Psychiatry, 13,

5. Katsutaro Nagata
WHO professor, psychosomatic medicine and psychopharmacology
Logotherapy approach to pain & illness
Logotherapy as effective treatment for chronic pain

6. Dimensions of Suffering (Mak, 2007)
Physical – physical symptoms & pain
Psychological – helplessness, hopelessness, & uncertainty
Social – isolation & relational conflict
Spiritual – lack of meaning in life
In her research with Chinese cancer patients, Mak emphasizes the importance of social and spiritual care.

7. The Good Death A comfortable & pain-free death A harmonious death
A meaningful death
A hopeful death
A peaceful death
Tolstoy’s story The Death of Ivan Ilyich: “he grows far beyond himself in the last hours of his life; he attains an inner greatness which retroactively hallows all of his previous life” (p.106)

8. The movie Ikiru by Akira Kurosawa (dir.):
The main character, Ikiru, found happiness by devoting his remaining days to building a playground for children. He did this after learning about his terminal cancer. (See my APA movie review of this film:

9. 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

10. 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

11. 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

12. Coping with Death Anxiety
Elizabeth Kubler-Ross’s (1969) five stages of coping
Denial – Death avoidance and extreme sports
Anger – Aggression, violence and terrorism
Bargaining – Doing good deeds or worshipping gods
Depression – Disengagement and isolation
Acceptance –Engagement in life
Many factors contribute to death anxiety:
Lack of personal knowledge and understanding of death
Fear of a slow and painful process of dying
Fear of dying all alone
Fear of not being able to care for those left behind
The uncertainty of when death will come and what will happen after death
Lack of adequate preparedness for its arrival
Lack of time to complete our major life projects
The sudden and irreversible ending of ongoing life
The complete breakup of all relationships
The loss of self and the world as we know it
The termination of all opportunities for meaning potentials
A permanent departure from the world of the living
A permanent goodbye to all the people and things we love.

13. Three Types of Death Acceptance (Wong, Reker, & Gesser, 1994)
Neutral - facing death rationally as an inevitable end of every life
Approach - accepting death as a gateway to a better afterlife
Escape - choosing death as a better alternative to a painful existence
Approach acceptance is rooted in religious/spiritual beliefs in a desirable afterlife, offering hope and comfort to the dying as well as the bereaved.
Escape acceptance is primarily based on the perception that life is so painful and miserable that death offers a welcome relief. In such cases, the terror of death seems less fearful than the terror of living.

14. Positive Death Acceptance
“Death Acceptance is the only antidote to Death Anxiety.”
Acceptance of one’s life as worthwhile
Readiness to let go things of this world
Recognition of the spiritual connection with a transcendental reality
Hope in sharing spiritual life with loved ones for all eternity

15. Pathways to Death Acceptance
Life review (Wong, 1995)
Self-acceptance (Wong, 1998)
Religious/spiritual beliefs (Wong, 1998)
Embracing one’s own life
Death education
To contemplate our death is to contemplate our life that leads to death.

16. Coping with Death Anxiety The Japanese Perspective
Naikan Therapy – focuses on inner looking & self-cultivation; life review of one’s relationship with a significant other, resulting in a more realistic sense of self & relationships
Morita Therapy – learning to accept & live with negative emotions without judgment, focuses on taking control of own behaviour in spite of how one feels

17. The Life-Death Connection
“To solve the problem of death, one must first solve the problem of life, living life” (Dennis Yoshikawa)
“To be prepared for death is to be prepared for living; to die well is to live well” (Konosuke Matsushita)
Facing death means to become aware of the transitoriness of human existence.
We can be preoccupied either with defense mechanisms against the terror of death or with responsible efforts to make the most of life.
How we have lived in responding to the transitoriness of life determines the meaning of our death.
The finiteness of life gives meaning to human existence rather than robbing it of meaning.
Frankl’s argument against death as the negation of meaning:
Immortality rather than mortality renders life meaningless.
Death challenges us to make the most of our opportunities.
Our responsibility in life is sharpened because of temporality and singularity (i.e., we only go through life once and encounter each situation only once).

18. “ Living well and dying well involve enhancing one’s sense of self, one’s relationships with others, and one’s understanding of the transcendent, the spiritual, the supernatural….” (Kuhl, 2002)

19. Living and Dying well through Meaning & Spirituality
Human beings are born with the innate need for meaning & spirituality.
Finding meaning and purpose can make a big difference in how we live & how we die.
The psychology of meaning management helps deepen our spirituality and existential understanding.
Meaning management helps construct an effective psychological and spiritual model.
Meaning management motivates us to embrace & assume responsibility for our personal lives.

20. Viktor Frankl & the Medical Ministry
Logotherapy is adjunct to medical treatments.
Healing needs to occur at the spiritual level.
Needs to address questions of suffering and death
Meaning can be found in the most horrible situations.
Needs to awaken the defiant human spirit
For more information, visit

21. What is Logotherapy?
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).
Logotherapy simply means therapy through meaning. More than any other forms of psychotherapy, logotherapy capitalizes on the characteristic of human beings as meaning-seeking and meaning-making, suffering beings (Homo patiente). Another defining characteristic of logotherapy is that it is a spiritually oriented approach toward psychotherapy. One of the prepositions of logotherapy is that the human spirit is our healthy core. The human spirit may be conceptualized as our basic yearning and capacity for meaning and spirituality.

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

23. The Tragic Triad
death
pain
guilt

24. The Neurotic Triad
addiction
depression
aggression

25. The Basic Tenets of 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 three basic tenets of logotherapy are: Freedom of choice, will to meaning, and meaning of life. All three tenets are essential for living a meaningful life. Freedom of choice simply emphasizes the human capacity for self-determination and choosing the right attitude even in the most restrictive circumstances. Will to Meaning refers to the primary intrinsic motivation of seeking meaning and living a meaningful life even for terminal patients. Will to meaning is essential for resilience and well-being; it can be best understood as the will to live in spite of pain and suffering (Frankl, 1969/1988). Meaning of life can be discovered until one’s last breath. This affirmation of meaning is based on the spiritual or noetic dimension. Fabry wrote: “People’s lives will be meaningful to the extent that their human spirit is able to tune in on the ‘Ultimate Meaning’ (Frankl, 1985, p. 141) in the suprahuman dimension of the Spirit (with a capital S)” (Fabry, 1998, pp. 297–298).

26. Freedom & Responsibility
Logotherapy emphasizes the responsible & meaningful use of freedom.
Human existence can only be understood in terms of responsibility.
The will to meaning is based on a sense of responsibility.
Responsibleness means meeting the demand quality of every situation.
“Human responsibility is a responsibility springing from the singularity and uniqueness of each man’s existence. Man’s existence is a responsibility springing from finiteness….This finiteness of life, the limited time man has upon this earth, does not make life meaningless. On the contrary, we are saying death itself is what makes life meaningful. We have said that a part of the singularity of life is the singularity of every situation….Part of the uniqueness of life is the uniqueness of every man’s destiny.” (Frankl, 1986, p. 74)
“With his unique destiny, each man stands, so to speak, alone in the entire cosmos.” (Frankl, 1986, p. 75)
“Man can preserve a vestige of spiritual freedom, of independence of mind, even in such terrible conditions of psychic and physical stress” (Frankl, 1985, p.86) as the Nazi concentration camps.
Make meaningful choices each day, each moment by seeing the larger picture and following our reasoning and intuitive conscience rather than impulse and instinct.
Frankl (1978) realizes that “Human freedom is finite freedom. Man is not free from conditions. But he is free to take a stand in regard to them. The conditions do not completely condition him” (p. 47). Frankl believes that although our existence is influenced instincts, inherited disposition, and environment, an area of freedom is always available to us. “Everything can be taken from a man, but…the last of the human freedoms -- to choose one’s attitude in any given set of circumstances, to choose one’s own way” (Frankl, 1963, p.104). Therefore, we all have the freedom to take a stand towards the deterministic conditions, to transcend our fate. In short, we always have to the freedom of will to transform negatives into positives, at least with respect to our attitudes.
Responsibility and responsibleness:
Frankl differentiated between responsibility and responsibleness. The former comes from possessing the freedom of will. The latter refers to exercising our freedom to make the right decisions and reactions to the demands of life. One of the objectives of logotherapy is to teach others the importance of responsibleness. Frankl (1984):
“We had to learn ourselves and, furthermore, we had to teach the despairing men that it did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life -- daily and hourly. Our answer must consist, not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfil the tasks which it constantly sets for each individual.” (p. 98).
“This emphasis on responsibleness is reflected in the categorical imperative of logotherapy, which is: Live as if you were living already for the second time and as if you had acted the first time as wrongly as you are about to act now”…Such a precept confronts him with life’s finiteness as well as the finality of what the makes out of both his life and himself.” (Frankl, 1984, pp )
Responsibleness is also derived from the life’s unique demands on each individual. Frankl (1967):
“Each man is unique and each man’s life is singular; no one is replaceable nor is his life repeatable. This two-fold uniqueness adds to man’s responsibleness. Ultimately, this responsibleness derives from the existential fact that life is a chain of questions which man has to answer by answering for life, to which he has to respond by being responsible, by making decisions, by deciding which answers to give to the individual question. And I venture to say that each question has only one answer -- the right one! This does not imply that man is always capable of finding the right answer or solution to each problem, or finding the true meaning of his existence. Rather, the contrary is true; as a finite being, he is not exempt from error, and, therefore, has to take the risk of erring.” (p. 31)
One of the therapeutic goals of logotherapy is to make clients conscious of their responsibility. Existential analysis aims at nothing more and nothing less than leading men to consciousness of their responsibility. (Frankl, 1986, p. 275)

27. The Will to Meaning It is the primary motivation for living.
Everyone needs to find the true meaning of one’s own life.
Will to meaning is essential for resilience and well-being to the extent that it means one’s capacity to live in spite of pain & suffering (similar to the will to live, “sei no yokubo”, in Meaningful Life Therapy)
“Finding meaning or the will to meaning is the primary motivation for living….the meaning that an individual finds is unique to each person and can be fulfilled only by that one person….Frankl emphasized that the true meaning of each person’s life is something that must be discovered by activity in the world through interaction with others, not solely through introspection….. Challenging a person with a potential meaning to fulfill evokes the will to meaning.” (Graber p. 65)
“Self-transcendence is called in logotherapy the ‘will to meaning’. If man can find and fulfill a meaning in his life, he becomes happy but also capable of coping with suffering. If he can see a meaning, he is even prepared to give his life.” (Frankl’s [1969] The Will to Meaning, as quoted in Graber, p. 296)
The emptiness and despair that people feel and their quest for meaning are evidence of the will to meaning.
There are many triggers of the will to meaning:
Challenging a person with a potential meaning to fulfill
Confronting a life crisis – every crisis is a new opportunity to find new elements of meaning in that situation
The delusion and emptiness after achieving success - “Is this all there is?”
Life transitions
Frankl (1967) likened the quest for ultimate meaning to the Israelites following the “cloud” in the biblical story of Exodus.
We are meaning-oriented. The will-to-meaning is “the basic striving of man to find and meaning and purpose” (Frankl, 1969, p. 35). The will-to-meaning is possible because of another human capacity and tendency of self-transcendence: “Being human is being always directed, and pointing to, something or someone other than oneself: to a meaning to fulfill or another human being to encounter, a cause to serve or a person to love” (Frankl, 1978, p. 35). As spiritual beings, individuals have the capacity to distance themselves from the psycho-biological organism and transcend their own limitations to achieve a higher purpose.

28. Meaning of Life
Life has meaning under all circumstances. It is our responsibility to respond to life’s demands.
Each person must discover the meaning potential of each situation.
The ultimate meaning lies in its pursuit.
The situational meaning can be experienced through three avenues of value.

29. Three Basic Pathways to Meaning
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.
Frankl’s three values of discovering meaning (creative, experiential, and attitudinal) are important in logotherapy, especially for cancer patients. Attitudinal value empowers patients to take a heroic stand and transform suffering into the highest form of human achievement. Life becomes meaningful to the extent that suffering holds positive meanings.

30. Schematic Representation of Human Dimensions
Spiritual
PSYCHOLOGICAL
Biological
Psychosomatic
Noetic
PERSONHOOD
Sociocultural Context l
Awareness of the
Spiritual Realm
Capacity to Know
God
Encounter with the
Transcendent
Perception
Learning &
Meaning
Higher
Cognitive
Social Processes
Physical
Health
Drives
Biochemical
Processes
Will to
Moral
Understanding
Beliefs and Values
Positive
Attitudes in
Suffering
Emotional States
Stress Reaction
Physical Pain
Sensation
This figure represents my understanding of Frankl’s noetic dimension.

31. Noetic Dimension The dimension of the human spirit
It is the healthy core or “medicine chest” of logotherapy.
It contains uniquely human attributes, such as: will to meaning, ideals, creativity, faith, love, conscience, self-detachment, self-transcendence, humor, goal-striving, and taking on commitments & responsibilities.
According to Fabry (1994), the noetic dimension or the human spirit is the “medicine chest” of logotherapy, containing such various inner resources as love, the will to meaning, purpose in life, hope, dignity, creativity, conscience, and the capacity for choice. Logotherapy focuses on activating the noetic dimension through a variety of therapeutic means, among them the appealing technique, modification of attitude, Socratic dialogue, paradoxical intention, and dereflection. It is worth noting that the current practice in academic psychology to define spirituality in terms of meaning and purpose (Wong, 1998b) is, to a large extent, influenced by Dr. Frankl’s emphasis of the spiritual nature of the noetic dimension.
“The inner dimension of the person is called the spirit. The spiritual core is the deepest centre of the person. It is here that the person is open to a transcendental dimension. It is here that the person experiences ultimate reality. Frankl’s logotherapy address that central spiritual core through psychotherapy. ” (Coulson, as cited in Graber p. 51)

32. What is Meaning Therapy?
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, meaning-making, and re-storying.

33. The Defining Characteristics of Meaning Therapy
Integrative/holistic
Existential/spiritual
Relational
Positively oriented
Multicultural
Narrative
Psycho-educational

34. Meaning Therapy is Integrative
Existential meaning – Logotherapy & Existential Therapy
Cognitive meaning – Cognitive-Behavioural Therapy 
Narrative meaning – Narrative Therapy
Positive meaning – Positive Psychotherapy
Cultural meaning – Cross-cultural & Indigenous Therapy
Over the past decade, I have elaborated on and extended Frankl’s classic logotherapy by incorporating cognitive-behavioral, narrative, cross-cultural, and positive therapies (Wong, 1998a, 2005, 2007, 2008).
Similar to logotherapy, Meaning Therapy attempts to awaken people’s awareness of the importance of spirituality, freedom, and responsibility in recovery and personal growth.

35. The Motto of Meaning Therapy
Meaning is all we need.
Relationship is all we have.
It is difficult to implement effective interventions when either one of the above conditions is missing.

36. 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.

37. Healing through Relationship
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.

38. 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.
At the professional level, the therapist is responsible for achieving desirable therapeutic goals.
Therapy involves the reciprocal influence between the therapist and the client.

39. 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 their true identity and place in the world.
To help the client pursue what really matters in life.

40. Therapeutic Goals Cont’d
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.

41. The Art of Questioning Responsibility questions Choice questions
Trajectory questions
Quest questions
Eight enduring existential questions
Magic questions
Diagnostic questions
Most of the questioning is Socratic, designed to awaken the defiant human spirit and a sense of responsibility.

42. Eight Enduring Existential Questions
Who am I?
How and where do I find happiness?
What should I do with my life?
How can I avoid making the wrong choices in the major areas of my life?
Where do I belong?
What is the point of all my striving?
What will happen to me after I die?
What would make my life more meaningful and significant?
These existential questions are needed to awaken or trigger the quest for meaning, which may be hidden in the unconscious.

43. 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
Wong (2011) further clarifies the definition of meaning as consisting of four interrelated components: purpose, understanding, responsibility, and enjoyment. (1) Purpose is the motivational component, including goals, directions, incentive objects, values, aspirations, and objectives. (2) Understanding is the cognitive component, encompassing a sense of coherence, appraisal of situations, understanding one’s own identity. (3) Responsible action is the behavioral component, including appropriate actions and reactions, doing the right thing. (4) Enjoyment is the affective component, including self-satisfaction from living a meaningful life and appreciation of the beauty of the world in which we live.

44. 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.
The PURE intervention focuses on what is good and what is right, while the ABCDE intervention focuses on what is negative and how to transform negatives into positives. Simply put, A stands for acceptance, B for belief and affirmation, C for commitment to specific goals and actions, D for discovering the meaning and significance of the self and situations, and E for evaluation of outcomes and enjoying the positive results. Tragic optimism and the ABCDE intervention are effective tools to treat trauma, disaster, and terminal illnesses.

45. 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.

46. Levels of Acceptance Cognitive acceptance Emotional acceptance
Realistic acceptance
Integrative acceptance
Existential acceptance
Transcendental acceptance
Transformative acceptance

47. 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

48. 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

49. 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.

50. 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.

51. SOURCES OF MEANING
According to Wong (1998), there are 8 sources of meaning and the good life.
Achievement
Acceptance
Transcendence
Intimacy
Relationship
Religion
Fairness
Positive emotions

53. Definition of a Meaningful Moment
It is deeply felt – It touches your emotions in a deep and lasting way. More than a fleeting feeling, it reaches your innermost being.
It is deeply processed – It involves deeper layers of meaning beyond the factual and superficial.
It is enlightening – It provides a solution to some puzzling problems or leads to some new discovery.
It is transforming – It enriches your life, changes your life’s direction or restores a sense of purpose and passion to your life.

54. The Meaning Mindset Life has intrinsic meaning and value.
My ultimate purpose is self-transcendence.
I can live at a deeper level by detecting the meaning & significance of any situation.
I can live at a higher plane by serving a higher purpose & being attuned to the transcendental realm.
I can live fully by integrating by my potentialities with my vulnerabilities moment by moment.

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

56. Meaning-mindset
Meaningful moments
PURE Framework
Sources of meaning
Frankl’s 3 basic tenets and values of meaning

57. Patterns of Resilience
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.

58. Four Life Trajectories

59. Elements of Tragic Optimism
Acceptance of the worst.
Affirmation of the value and meaning of life.
Self-transcendence (altruism).
Faith in God and others.
Courage to face adversity.
Frankl originally developed the concept of Tragic Optimism based on his experience in a Nazi concentration camp.

60. Conclusion
Meaning is a key component in spiritual care for cancer patients.
Logotherapy focuses on the responsibility to discover & fulfill the will to meaning through self-transcendence & authentic living.
Meaning therapy is integrative. It focuses on the human capacity for meaning-seeking & meaning-making.
In sum, logotherapy and MT equip clinicians with the fundamental principles and skills to (a) help clients develop a healthy understanding of their true identity and place in the world; (b) motivate and empower clients in their struggle for survival and fulfillment regardless of their life circumstances; (c) tap into people’s capacity for meaning construction in order to help clients make sense of their predicaments and restore their purpose, faith, and hope; (d) provide necessary tools for clients to overcome personal difficulties and anxieties and fulfill their life’s mission; and (e) establish a genuine healing relationship with clients and enhance their capacity to trust and relate with others.