Meaning-Centered Counselling & Spiritual

Care

The Alberta Pastoral Care Association 45th Annual

ConferenceApril 15 - 16, 2013

© Paul T. P. Wong, Ph.D., C.Psych

Overview

• The general characteristics of Meaning Therapy (short name of Meaning-Centered Counselling & Therapy)

• The basic the principles and practices of Meaning Therapy

• Meaning Therapy & Spiritual Care

• It evolved 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.

Wong’s Meaning Therapy

From Logotherapy to Meaning Therapy

• Logotherapy was an adjunct to psychotherapy and medical practice.

• Meaning Therapy is an integrative psychotherapy.

• Meaning Therapy elevates the motif of meaning into a symphony.

• Meaning Therapy is more anchored in empirical research.

Existential Positive Psychology (EPP)

• By definition, EPP integrates the positive potentials & negative potentials of human existence.

• The main thrust of EPP is the positive transformation of life as a whole.

Sources of Positivity

• God is the source of all blessings

• Life itself is a gift from God

• The human potential for growth, spirituality, & goodness

• There is beauty, truth, & kindness in the world

• Positive emotions & traits

Sources of Suffering

• Natural disasters

• Man-made disasters

• Existential anxieties

• Spiritual deadness

• Inner brokenness

• Breakdown of relationship

• Physical illness & pain

Dimensions of Suffering (Mak, 2007)

• Physical – physical symptoms & pain

• Psychological – helplessness, hopelessness, & uncertainty

• Social – isolation & relational conflict

• Spiritual – lack of meaning in life

The Challenge of Meaning Therapy

• How to tap into sources of positivity to transform or transcend negativity & suffering

• How to capitalize on the human capacity for spirituality & meaning seeking/making to achieve personal & social transformation

The Motto of Meaning Therapy

Meaning is all we have; relationship is all we need.

•Human beings are meaning seeking/making beings, living in a world of meaning.

•Relationship is all we need to help clients:

Relationship itself heals.

How to relate to self & others is the basis for healthy living.

Every problem exists in a relational network.

Meaning as the Central Construct

Meaning Therapy integrates different approaches of psychotherapy with meaning as the central construct.

Cognitive Meaning – Cognitive Behavioural Therapy

Existential/Spiritual Meaning – Existential Therapy & Spiritual Care

Narrative Meaning – Narrative Therapy

Unconscious Meaning – Psychoanalytic Therapy

Cultural Meaning – Cross-Cultural Therapy

• Integrative/holistic• Existential/spiritual• Relational• Positively oriented• Multicultural• Narrative• Psycho-educational

The Defining Characteristics of Meaning Therapy

Sources of Meaning

1. Achievement

2. Acceptance

3. Transcendence

4. Intimacy

5. Relationship

6. Religion

7. Fairness

8. Positive emotions

According to Wong (1998), there are 8 sources of meaning and the good life.

1. It is deeply felt – It touches your emotions in a deep and lasting way. More than a fleeting feeling, it reaches your innermost 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

The Meaning Mindset1. Life has intrinsic meaning and value.

2. My ultimate purpose is self-transcendence.

3. I can live at a deeper level by detecting the meaning & significance of any situation.

4. I can live at a higher plane by serving a higher purpose & being attuned to the transcendental realm.

5. I can live fully by integrating my potentialities with my vulnerabilities moment by moment.

1. I can find something meaningful or significant in everyday events. 1 2 3 4 5

2. There is a reason for everything that happens to me. 1 2 3 4 5

3. There is no ultimate meaning and purpose in life. 1 2 3 4 5

4. There is no point in searching for meaning in life. 1 2 3 4 5

5. No matter how painful the situation, life is still worth living. 1 2 3 4 5

6. The meaning of life is to “eat, drink and be happy”. 1 2 3 4 5

7. What really matters to me is to pursue a higher purpose or calling regardless of personal cost. 1 2 3 4 5

8. I would rather be a happy pig than a sad saint. 1 2 3 4 5

9. I am willing to sacrifice personal interests for the greater good. 1 2 3 4 5

10.Personal happiness and success are more important to me than achieving inner goodness and moral excellence. 1 2 3 4 5

Life Orientation Scale

Principles of Relationship

• Relationship is more than therapeutic alliance

• Relationship is more than relational therapy (overcoming relational deficits)

• The principles of relationship include 1. Presence2. Rogerian principles3. Learning new patterns of relating

• 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

Rogerian Principles

• New patterns of relating based on trust & authenticity

• The dynamic of moment-to-moment interaction provides windows for therapy

• Accepting resistance and negative reaction as part of the healing process

Healing through Relationship

Healing through Relationship (Cont.)

• The ground rule of respect and caring applied to both the therapist and the client

• Recognize that each individual is both unique and similar

• Empower the client to discover his or her own path, no matter how painful

• 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 and their authentic selves

• At the professional level, the therapist is responsible for achieving desirable therapeutic goals

Different Levels of Relating

• 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 his or her true identity and place in the world

• To help the client pursue what really matters in life

Therapeutic Goals

• To develop the client’s full potential

• To make life better for self & others

• To transform a victim’s journey into a hero’s adventure

• To discover meaning and hope in boundary situations

• To transform negatives into positives through meaning seeking/making

Therapeutic Goals (cont.)

• Responsibility questions• Choice questions• Trajectory questions• Quest questions• Magic questions• Diagnostic questions

The Art of Questioning

1. Who am I?

2. What do I want? What really matters in my life?

3. How and where can I find happiness?

4. What should I do with my life?

5. How can I avoid making the wrong choices?

6. Where do I belong? Where is my home?

7. What is the point of all my striving?

8. What will happen to me after I die?

Eight Enduring Existential Questions

Intervention Strategies

1. The PURE Strategy

2. The ABCDE Strategy

3. The Double Vision Strategy

4. The Dual Systems Strategy

The four treasures of Meaning Therapy:

Purpose – the motivational component

Understanding – the cognitive component

Responsible action – the behavioral component

Enjoyment – the affective component

The PURE Principles

• 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 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 worst fears with courage and tragic optimism

• Transcending and transforming the tragedy

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

• 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

Belief

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

• 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 worst is over

•Savoring the moments of small success

•Reflecting and reviewing one’s life

•Receiving feedback from others

•Conducting assessments and making adjustments

Evaluation

The Double Vision Strategy

Meaning-mindset

Meaningful moments

PURE Framework

Sources of meaning

Frankl’s 3 basic tenets and values of meaning

A Dual-Systems Model of Living the Good Life

Seeking what is meaningful

Transforming what is negative

The Goo

d Life

Enjoying the present moment

Letting go

Ap

pro

ach

Avo

ida

nce

© Paul T. P. Wong

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

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

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

Current Trends in Spirituality and Health

• Breaking down the barriers between the medicine, psychotherapy, and religion

• The inadequacy of a technological, cure-based medical model

• Increasing recognition of the role of spirituality in health care

Current Trends (cont.)

• No medication for broken hearts or wounded souls

• The need for compassionate care (Puchalski, 2001)

• The need for spiritual care and spiritual transformation

What is Compassionate Care?

• “Serving patients may involve spending time with them, holding their hands, and talking about what is important to them” (Pychalski, 2001)

• “The word compassion means ‘to suffer with.’ Compassionate care calls physicians to walk with people in the midst of their pain, to be partners with patients rather than experts dictating information to them” (Puchalski, 2001)

A Holistic Approach to Health Care

• The person is dimensional and unified • Wong’s schematic presentation• Caring for physical, psychological,

existential, and spiritual needs• Cure is not possible for many illnesses• Healing is possible in all illnesses• The core of healing is spiritual

Spirituality & Health

• Spiritual hunger: A universal human need

• The biological basis of spirituality

• Spiritual being vs. Spiritual awakening

• Spirituality vs. Religion

• Intrinsic vs. Extrinsic religion

• Part of the medical curriculum

The Role of Faith and Spirituality in Health

• Prayer contributes to healing and recovery

• Faith enhances quality of life, hope, and happiness

• Religious beliefs affect medical decisions

• Spiritual beliefs facilitate death acceptance

• Coping with chronic pain, disability and terminal illnesses

• Addressing existential issues

• Making it an integral part of holistic care

Empirical Findings on the Benefits of Faith

• Greater longevity• Higher quality-of-life score• Lower blood pressure• Fewer cardiovascular problems• Fewer cases of depression & anxiety• Better immune functioning • Faster recovery from surgery• Healthy life style

Be a Spiritually Transformed Healer

• Understanding your own spiritual needs

• Nurturing your own spirituality

• Treating spirituality as part of personal & professional development

• Caring for the wounded healer

• Viewing the world from a spiritual lens

• Transforming spiritual care into Divine care

Conclusion

• Meaning is a key component in spiritual care for cancer patients.

• Meaning therapy is integrative. It focuses on the human capacity for meaning-seeking & meaning-making.