THROUGH A BIO-PSYCHO-SOCIAL-SPIRITUAL CONTEXT
Panel Discussion:
Social and Cultural Constructions of Meaning, and Meaning-Oriented Interventions, with A. Batthyany, M. Dezelic, M. Kwee, D. Leontiev, K. Salagame, Chair P. Wong
An ultimate challenge for all human beings is to be able to find, maintain and even enhance meaning in our lives despite the inevitable pain and suffering from illness, loss, conflict, traumas, tragedies, setbacks and limitations, encountered in the human experience. All of us face this challenge, and at one point or another during the course of our lifetime, it can possibly result in despair, hopelessness or meaninglessness.
The difficulty to this challenge that we encounter is in the definition of Meaning. Meaning is a universal concept, yet it does not have a universal, operational definition, precisely because of social and cultural constructions. Additionally, Meaning also has two very different perspectives in its general definition. Simply put, one area of Meaning can be defined as relating to the “understanding” of something (when something happens, it means…); and the other area of Meaning can be defined as relating to an overall understanding and “greater purpose” or “significance” (such as the meaning of life, or one was able to find meaning within the suffering). For both of these aspects of meaning, the actual definition becomes an individual’s creative and dynamic interpretation, within cognitive, behavioral and emotive appraisals of inner and outer world experiences, as one grows and develops, within their particular environment of social and cultural cues.
A Meaning construct can essentially be described as the central process of navigating our way through our lifetime. This construct is formed by the specifics of: Biological (age and brain development), Personal (temperament and personality styles), Relational-Social (attachment style, support and mediating factors), Cultural (including the culture of the region, race, gender, and religious or faith-based beliefs).
The meaning construct process can be understood through a 3-step process of assimilating and integrating a new meaning construct as new and novel experiences unfold throughout one’s lifetime: 1) Experience: the initial experience, the actual sensory experience; 2) Meaning: the discovering and making sense of it through the factors of biological, personal, relational-social, and cultural; 3) Assimilation: the integration of the experience and meaning (or significance) derived and synthesized into the self and world views. Then total individual meaning constructs and appraisals become a series of links to previous meaning constructs, adapting and adjusting, incorporating previous constructs and disregarding aspects, and follow with developing and changing meaning constructions as new experiences are introduced and integrated. Often times, individuals get stuck in the Meaning stage, trying to make sense of the situation, or between Meaning and Assimilation, when one understands the new experience, yet is having trouble finding adaptive ways of integrating the experience and appraised meaning within their framework.
We can never assume we understand one’s particular meaning to an event, circumstance, or contact because it is a combination and interactional effect of all of the above factors. On the background of cognitive, behavioral and emotive appraisals of self and world views, through the developing framework of biological, personal, social-relational, and cultural, the meaning-making process is incorporated and integrated into one’s life. As an example, the fundamental meaning of making or not making eye contact, body proximity when speaking with someone, greetings with a kiss, embrace, or handshake, are all interpreted and represent different individual concepts and imply particular messages depending on social and cultural aspects. And we need to be sensitive to these idiosyncratic understandings. Likewise, meaning—significance and purpose—in life, a central concept in Meaning-Centered therapies, also has different interpretations across cultures for the very same reasons. The “meaning” of meaning in life is unique for each individual. The search for meaning in life itself, is an innate and inherent pulling force within human beings, yet the outcomes of what is interpreted as meaningful and significant in one’s life varies across the globe.
Meaning-centered therapies do not claim to stand on their own, yet they can address a specific component underlying and throughout various issues, symptoms and diagnoses. They are existential and humanistic theories, with integrative qualities because they deal with the entirety of the human existence and human phenomena, often combining psychodynamic, behavioral, cognitive, affective, somatic and transpersonal theories and techniques within the scope of the therapeutic process. Meaning-centered therapies address both types of meaning (understanding, and greater significance and purpose) for an individual, couple, family system or group, taking into consideration the biological, personal, social-relational and cultural aspects, as well as any particular and unique life experiences as mediating factors, such as traumas, deaths, disruptions, natural disasters, wars, governmental sanctions, etcetera.
Logotherapy & Existential Analysis, a Meaning-centered psychotherapeutic approach originally developed by Viktor Frankl, as the third Viennese school of psychotherapy, and several other meaning-based existential approaches are now being recognized as evidence-based practices and effective treatments for issues involving meaning in life and overall meaninglessness and despair, as well as other existential issues with varied psychiatric diagnoses across clinical settings. Meaning-Centered Logotherapy & Existential Analysis, assists individuals to become conscious of themselves, through self-awareness and self-discovery of one’s overall existence and life experience, and one’s inherent search for meaning through an ontological framework of mind, body, and spirit (the unique essence of the individual, in a non-religious context). The meaning-based interventions help individuals to lessen the impact of despair, hopelessness and meaninglessness, mediate reactive responses, discover meaning in life, and ultimately assist individuals to modify their attitudes toward unavoidable situations and suffering, while activating meaning through creativity, experiences and attitudes.
The existential therapeutic process assists individuals 1) To recognize strengths and weaknesses, and utilize both for growth; 2) Facilitate a greater understanding of the human condition and the experiences within it from the personal context; 3) Uncover and discover inner strengths and resources to live passionate, fulfilling and meaningful lives; 3) To live authentically, heal traumas, and have personal and relational growth.
“When we are no longer able to change a situation, we are challenged to change ourselves.” (V. Frankl)
REACH Model "Conceptual Pictograph:"
The “REACH Beyond the Limitations: Sources of Meaning in Life” Conceptual Pictograph, was designed by M. Dezelic, PhD, W. Breitbart, MD, and G. Ghanoum, PsyD, based on Dr. William Breitbart’s work and clinical research with randomized controlled trials of his Meaning-centered group psychotherapy (MCGP) and Individual meaning-centered psychotherapy (IMCP) involving the REACH acronym components: R) Responsibility; E) Experiential sources; A) Attitudinal sources; C) Creative sources; H) Historical sources. Dr. Breitbart’s upcoming manualized treatment workbooks for MCGP and IMCP will be available soon, titled: Meaning-Centered Group Psychotherapy for Patients with Advanced Cancer: A Treatment Manual, and Individual Meaning-Centered Psychotherapy for Patients with Advanced Cancer: A Treatment Manual.
Viktor Frankl’s key concepts from Logotherapy and Existential Analysis of meaning in life, responsibility and spirituality, inspired the applications and exercises in Bretibart’s psychotherapeutic work with advanced cancer patients, many of whom seek guidance and support in addressing issues of sustaining meaning in life despite their diagnosis, hope in the face of death, understanding cancer and their impending death in the scope of their lives.
The particular interventions, within the eight sessions for group psychotherapy and seven sessions for individual psychotherapy, developed and rigorously tested by Breitbart and his colleagues at the Department of Psychiatry & Behavioral Sciences at Memorial Sloan-Kettering Cancer Center in New York City, NY, USA, utilize a mixture of didactics, discussion and experiential exercises that focus around particular themes related to meaning in life and advanced cancer. The themes of the REACH components, Responsibility, Experiential values, Attitudinal values, Creative values, and Historical values, can be found within each session; patients are assigned readings and homework that are specific to each session's theme, which are then utilized in the sessions, with the goal to engage the patients toward finding meaning and purpose in life in the face of terminal illness and impending death.
The results of the randomized controlled trials comparing the manualized meaning-centered interventions of MCGP and IMCP to supportive psychotherapy showed significant increase in spiritual well-being and sense of meaning in life, improvements in anxiety, and reduction of end-of-life despair, such as hopelessness and desire for hastened death, as well as significant increased benefits in the two-month follow-up assessments for MCGP and IMCP; there were no noted significant improvements on any of these variables for Supportive psychotherapy participants. Specifically, when responses to the Schedule of Attitudes Toward Hastened Death assessment were analyzed, the item “Despite my illness, my life has meaning and purpose,” increased substantially following the manualized interventions published in the upcoming workbooks. The assessment battery utilized yielding these results included the FACIT Spiritual Well-Being Scale (SWB), the Beck Hopelessness Scale (BHS), the Schedule of Attitudes toward Hastened Death (SAHD), the Life Orientation Test (LOT), and the Hospital Anxiety and Depression Scale (HADS).
The idea behind this Conceptual Pictograph was to have a visual, conceptual representation of the main components of the theory and the therapy process for clinicians, based off of the concepts utilized in the treatment manuals, and as a handout for patients, to be able to synthesize key concepts of their therapeutic process, as well as to have a reminder. Breitbart’s manuals utilize specific components of Frank’s Logotherapy & Existential Analysis, namely the meaning triangle (creativity, experiences, and attitude), responsibility and spirituality, yet bring these concepts in a novel approach and format, with specifically designed exercises, and offers a significant increase in meaning in life through the brief 7 and 8 sessions format. These manualized sessions can be adapted or tailored to other populations that are not necessarily facing end of life or terminal illness, and Breitbart and colleagues are currently working on those adaptations for specific populations. The exercises in the workbooks can be further explored in existential therapies, and expounded upon for a more in-depth analysis with other Logotherapeutic meaning-centered techniques for longer-term therapies.
These Handouts are meant for Mind-Body-Spirit (bio-psycho-social-spiritual) awareness and self-help empowerment. ENJOY!
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