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Writing Can Help Us Heal from Trauma

• Deborah Siegel-Acevedo

Three prompts to get started.

Why does a writing intervention work? While it may seem counterintuitive that writing about negative experiences has a positive effect, some have posited that narrating the story of a past negative event or an ongoing anxiety “frees up” cognitive resources. Research suggests that trauma damages brain tissue, but that when people translate their emotional experience into words, they may be changing the way it is organized in the brain. This matters, both personally and professionally. In a moment still permeated with epic stress and loss, we need to call in all possible supports. So, what does this look like in practice, and how can you put this powerful tool into effect? The author offers three practices, with prompts, to get you started.

Even as we inoculate our bodies and seemingly move out of the pandemic, psychologically we are still moving through it. We owe it to ourselves — and our coworkers — to make space for processing this individual and collective trauma. A recent op-ed in the New York Times Sunday Review affirms what I, as a writer and professor of writing, have witnessed repeatedly, up close: expressive writing can heal us.

• Deborah Siegel-Acevedo is an author , TEDx speaker, and founder of Bold Voice Collaborative , an organization fostering growth, resilience, and community through storytelling for individuals and organizations. An adjunct faculty member at DePaul University’s College of Communication, her writing has appeared in venues including The Washington Post, The Guardian, and CNN.com.

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Narrative Therapy: Definition, Techniques & Interventions

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

Learn about our Editorial Process

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

On This Page:

Narrative therapy, is a powerful psychotherapeutic approach that empowers clients to explore and reshape their life stories, particularly those overwhelmed by challenges and emotional distress.

During sessions, clients engage in open dialogues with their therapists, delving into their narratives and actively challenging the ones that contribute to their struggles.

By separating problems from personal identity, narrative therapy emphasizes the belief that individuals are the ultimate authorities in their own lives.

Through this collaborative process, clients gain a deep understanding of their values and skills, enabling them to effectively confront present and future issues and pave the way for transformative change.

When was narrative therapy developed?

Narrative therapy was developed in the 1980s by therapists Michael White and David Epston. It is still a relatively novel approach to therapy that seeks to have an empowering effect and offer therapy that is non-blaming and non-pathological in nature.

What is a narrative?

A narrative is a story. As humans, we have many stories about ourselves, others, our abilities, our self-esteem , and our work, among many others.

How we have developed these stories is determined by how we have linked certain events together in a sequence and by the meaning attributed to them.

We like to interpret daily experiences in life, seeking to make them meaningful. The stories we have about our lives are created through linking certain events together in a particular sequence across a period of time and finding ways of making sense of them – this meaning forms the plot of the story.

As more and more events are selected and gathered into the dominant plot, the story gains richness and thickness.

The idea is that identity is formed by an individual’s life narrative, and several narratives are at work at once. The interpretation of a narrative can influence thinking, feelings, and behavior.

Many narratives are useful and healthy, whereas others can result in mental distress. Mental health symptoms can come about when there is an unhealthy or negative narrative or if there is a misunderstanding or misinterpretation of a narrative.

What is the aim of narrative therapy?

Narrative therapy seeks to change a problematic narrative into a more productive or healthier one.  This is often done by assigning the person the role of narrator in their own story.

Narrative therapy helps to separate the person from the problem and empowers the person to rely on their own skills to minimize problems that exist in their lives.

This therapy aims to teach the person to view alternative stories and address their issues in a more productive way.

Narrative therapy can be used with individuals but can also prove useful for couples or families.

Narrative therapists are also not interested in diagnosing individuals – there is no use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) during any point of the therapy.

What is the role of the therapist?

The role of the narrative therapist is to search for an alternative way of understanding a client’s narrative or an alternative way to describe it.

The belief is that telling a story is a form of action toward change. Therefore, the therapist will help clients to objectify their problems, frame these problems within a larger sociocultural context, and teach the person how to make room for other stories.

During therapy, the therapist acts as a non-directive collaborator. They treat the client as the expert on their own problems and do not impose judgments.

Instead, the therapist is purely curious and investigative. They are not particularly interested in the cause of a problem but are open to a client’s perception of the cause.

Narrative Therapy Techniques

Putting together the narrative

The therapists help their clients to put together their narratives. This will usually involve listening to the client explain their stories and any issues that they want to bring up.

This allows the person to express their thoughts and explore events in their lives and the meanings they have placed on these experiences.

The therapist may find what is known as a ‘problem-saturated narrative’ comes up, which will be what is causing the client the most distress.

As the story comes together, the client becomes an observer of their story and can then review this with the therapist.

When the therapist communicates to the client during this stage, they will make sure to utilize the client’s use of language since the client is treated as the expert in their narrative.

Externalizing the problem

Once the story is put together, the idea is that it allows the client to observe themselves. The therapist encourages the client to create distance between the individual and their problems, called externalization.

The externalization techniques lead clients towards viewing their problems or behaviors as external instead of an unchangeable part of themselves.

The therapist may ask the client to give a name to the problem so it is seen as a separate entity, such as ‘anger’ or ‘worry.’ The client will then be encouraged to use the given name of the problem when talking about it. Likewise, the therapist will ask questions referring to the problem by the given name.

The distance given to the problem allows people to focus on changing unwanted behaviors.

As people practice externalization, they will see that they can change. The general idea is that it is easier to change a behavior that they do than to change a core personality characteristic.

They will realize that they themselves are not the problem; instead, the problem is the problem.

Deconstruction

Often, when a client has a problematic story, especially when it has been prevalent for a long time, the problem can feel overwhelming, confusing, or unsolvable.

Because of these feelings, people can use overgeneralized statements which can make the problematic stories worse.

The narrative therapist would work with the individual to break down or deconstruct their stories into smaller, more manageable parts to clarify the problem.

Deconstructing makes the problems more specific and reduces overgeneralizing; it also clarifies what the core issue or issues may be. Through deconstructing, the whole picture becomes easier to understand.

The therapist and client may also seek to deconstruct identity and have an awareness of larger societal issues, e.g., sociocultural and political effects which may be acting on the client.

They may find that the context of gender, class, race, culture, and sexual identity also play a part in the interpretations and meanings given to events.

Unique outcomes

When someone’s problematic stories are well established, people can become stuck in them, unable to view alternative versions of the story. A narrative therapist will help people challenge their stories and encourage them to consider alternative stories.

Unique outcomes refer to the exceptions to the dominant story. It may also be known as ‘re-authoring’ or ‘re-storying,’ as clients go through their experiences to find alterations to their story or make a whole new one.

There are hundreds of different stories since everyone interprets experiences differently and finds their own meaning from them. The therapist will help the client to build upon an alternative or preferred story.

These unique outcomes contrast a problem, reflect a person’s true nature, and allow someone to rewrite their story.

Building upon stories from another perspective can help to overcome problems and build the confidence the person needs to heal from them.

Benefits of narrative therapy

Empowers the individual.

As this therapy stresses that people do not label themselves negatively (e.g., as the problem), this can help them feel less powerless in distressing situations.

They find that they have more control over the stories they have in their lives and how they approach difficult events.

Narrative therapy treats individuals with respect and supports the bravery it has taken for them to choose to work through their personal challenges.

Non-confrontational

This is a non-judgmental approach to therapy, meaning that the clients are not blamed for anything described in their stories.

Likewise, the clients are encouraged not to blame others or themselves. The focus is instead placed on noticing and changing unhelpful stories about themselves and others.

The client is treated as an expert

Narrative therapy does not aim to change a person; rather, it allows them to become an expert in their own lives.

The therapist holds that the clients know themselves well and work as collaborative partners with the client.

This therapy allows people to not only find their voice but to use this voice for good, enabling them to become experts and live in a way that reflects their goals and values.

Context is considered

This therapy may also help the client view their problems differently. These can be social, political, and cultural, among others.

The clients recognize that these contexts matter and can influence how they view themselves and their stories.

What can narrative therapy help with?

Narrative therapy may help treat the symptoms of a variety of conditions, including:

Anxiety disorders

Depressive disorders

Eating disorders

Attention deficit hyperactivity disorder ( ADHD )

Posttraumatic stress disorder (PTSD)

As well as mental health conditions, narrative therapy may also be useful for the following:

Those who feel like they are overwhelmed by negative experiences, thoughts, or emotions.

Those with attachment issues .

Those who are suffering from grief.

Those who have issues with low self-esteem.

Those who often feel powerless in many situations.

How is narrative therapy used?

For individuals, narrative therapy challenges the dominant problematic stories that prevent people from living their best lives.

Through the externalizing technique, people can learn to separate themselves from the problem.

They learn to identify alternative stories, widen their views of themselves, challenge old and unhealthy beliefs, and be open to new ways of living that reflect a more accurate and healthier story.

For couples or families, externalizing problems can facilitate positive interaction.

It can also make negative communication more accepting and meaningful. Seeing problems objectively can help couples and families reconnect and strengthen their relationships.

Once problems have been identified, this can be used to address how the problem has challenged the core strength of their bond.

How effective is narrative therapy?

Below are some of the studies which have investigated the effectiveness of narrative therapy:

A research study looked at evaluating the effectiveness of narrative therapy in increasing couples’ intimacy and its dimensions.

The results showed that this therapy significantly increased intimacy and on three dimensions of emotional, communication, and general intimacy, concluding that narrative therapy can provide valuable implications for the mental health of couples (Khodabakhsh et al., 2015).

Research has found that married women experienced increased levels of marital satisfaction after being treated with narrative therapy (Ghavibazou et al., 2020).

A study of adults with depression and anxiety looked at the effects of narrative therapy and found improvements in their self-reports of quality of life, and they had decreased symptoms of anxiety and depression (Shakeri et al., 2020).

A small sample pilot study aimed to determine whether narrative therapy was effective in helping young people with Autism who present with emotional and behavioral difficulties.

It was found that there were significant improvements in psychological distress and emotional symptoms (Cashin et al., 2013).

A study looked at the effectiveness of narrative therapy in boosting 8-10-year old’s social and emotional skills. The results showed that the children showed significant improvements in self-awareness, self-management, empathy, and responsible decision-making (Beaudoin et al., 2016).

A study explored group narrative therapy for improving the school behavior of a small sample of girls with attention deficit hyperactivity disorder (ADHD).

Posttreatment ratings by teachers showed that there was a significant effect on reducing ADHD symptoms one week after completing the therapy sessions, and this was sustained after 30 days (Looyeh et al., 2012).

Limitations

One of the major limitations of narrative therapy is that research into its effectiveness is still lacking.

Further research is also needed to determine what mental health conditions narrative therapy might treat most effectively.

A reason for the lack of research is that it is still a relatively new approach to therapy. Another reason could be due to it being difficult to quantify.

The view that narrative therapists have is that knowledge is subjective and constructed by each person.

They accept there is no universal truth, so some narrative therapists make the argument that this therapy should be studied qualitatively rather than quantitatively.

How to get started

Narrative therapy is a specialized approach to counseling with training opportunities for therapists to learn how to use this approach with clients.

Finding the right therapist can involve looking online through therapist directories. Alternatively, you may consider asking your doctor to refer you to a professional in your area with the right training and experience.

It is important to choose the right therapist for you. Consider whether you feel comfortable discussing personal information with them. Don’t be afraid to seek a different therapist if the one you have does not quite suit your needs.

When choosing a therapist, consider thinking about what your deal breakers are, important qualities, and any other characteristics you value. 

What questions can you ask yourself when considering therapy?

When you are ready to select a therapist, think about the following:

1. What type of therapy do you want? – Do you want individual, couples, family therapy, or another type?

2. What are your main goals for therapy?

3. Whether you can commit the time each week – what days and times are most convenient for you?

What can be expected during the first therapy session?

During the first narrative therapy session, the therapist may ask you to begin sharing your story, and they may ask questions about why you are seeking treatment.

The therapist may also want to know about how your problems are affecting your life and what your goals for the future are.

Furthermore, they are likely to discuss aspects of treatment, such as how often you will meet and how your treatment may change from one session to the next.

What are some considerations for narrative therapy?

This therapy can be very in-depth, exploring a wide range of factors that can influence the development of your stories.

It also involves talking about problems as well as strengths which may be difficult for some people.

The therapist will help you to explore your dominant story in-depth and discover how it may be contributing to emotional distress, as well as uncover strengths that can help you to approach your problems differently.

You should expect to re-evaluate your judgments about yourself since narrative therapy encourages you to challenge and reassess these thoughts and replace them with more realistic or positive ones.

It also challenges you to separate yourself from your problems which can be difficult, but this process helps you learn to give yourself credit for making the right decisions for you.

Do you need mental health help?

Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/

1-800-273-8255

Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email [email protected] .

Available 24 hours a day, 365 days a year (this number is FREE to call):

Rethink Mental Illness: rethink.org

0300 5000 927

Further Information

Wallis, J., Burns, J., & Capdevila, R. (2011). What is narrative therapy and what is it not? The usefulness of Q methodology to explore accounts of White and Epston’s (1990) approach to narrative therapy. Clinical Psychology & Psychotherapy, 18(6), 486-497.

Hutto, D. D., & Gallagher, S. (2017). Re-Authoring narrative therapy: Improving our selfmanagement tools. Philosophy, Psychiatry, & Psychology, 24(2), 157-167.

Morgan, A. (2000). What is narrative therapy? (p. 116). Adelaide: Dulwich Centre Publications.

Beaudoin, M. N., Moersch, M., & Evare, B. S. (2016). The effectiveness of narrative therapy with children’s social and emotional skill development: an empirical study of 813 problem-solving stories. Journal of Systemic Therapies, 35(3), 42-59.

Cashin, A., Browne, G., Bradbury, J., & Mulder, A. (2013). The effectiveness of narrative therapy with young people with autism. Journal of Child and Adolescent Psychiatric Nursing, 26(1), 32-41.

Ghavibazou, E., Hosseinian, S., & Abdollahi, A. (2020). Effectiveness of narrative therapy on communication patterns for women experiencing low marital satisfaction. Australian and New Zealand Journal of Family Therapy, 41(2), 195-207.

Khodabakhsh, M. R., Kiani, F., Noori Tirtashi, E., & Khastwo Hashjin, H. (2015). The effectiveness of narrative therapy on increasing couples intimacy and its dimensions: Implication for treatment. Family Counseling and Psychotherapy, 4(4), 607-632.

Looyeh, M. Y., Kamali, K., & Shafieian, R. (2012). An exploratory study of the effectiveness of group narrative therapy on the school behavior of girls with attention-deficit/hyperactivity symptoms. Archives of Psychiatric Nursing, 26(5), 404-410.

Shakeri, J., Ahmadi, S. M., Maleki, F., Hesami, M. R., Moghadam, A. P., Ahmadzade, A., Shirzadi, M. & Elahi, A. (2020). Effectiveness of group narrative therapy on depression, quality of life, and anxiety in people with amphetamine addiction: a randomized clinical trial. Iranian Journal of Medical Sciences, 45(2), 91.

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The state of AI in early 2024: Gen AI adoption spikes and starts to generate value

If 2023 was the year the world discovered generative AI (gen AI) , 2024 is the year organizations truly began using—and deriving business value from—this new technology. In the latest McKinsey Global Survey  on AI, 65 percent of respondents report that their organizations are regularly using gen AI, nearly double the percentage from our previous survey just ten months ago. Respondents’ expectations for gen AI’s impact remain as high as they were last year , with three-quarters predicting that gen AI will lead to significant or disruptive change in their industries in the years ahead.

About the authors

This article is a collaborative effort by Alex Singla , Alexander Sukharevsky , Lareina Yee , and Michael Chui , with Bryce Hall , representing views from QuantumBlack, AI by McKinsey, and McKinsey Digital.

Organizations are already seeing material benefits from gen AI use, reporting both cost decreases and revenue jumps in the business units deploying the technology. The survey also provides insights into the kinds of risks presented by gen AI—most notably, inaccuracy—as well as the emerging practices of top performers to mitigate those challenges and capture value.

AI adoption surges

Interest in generative AI has also brightened the spotlight on a broader set of AI capabilities. For the past six years, AI adoption by respondents’ organizations has hovered at about 50 percent. This year, the survey finds that adoption has jumped to 72 percent (Exhibit 1). And the interest is truly global in scope. Our 2023 survey found that AI adoption did not reach 66 percent in any region; however, this year more than two-thirds of respondents in nearly every region say their organizations are using AI. 1 Organizations based in Central and South America are the exception, with 58 percent of respondents working for organizations based in Central and South America reporting AI adoption. Looking by industry, the biggest increase in adoption can be found in professional services. 2 Includes respondents working for organizations focused on human resources, legal services, management consulting, market research, R&D, tax preparation, and training.

Also, responses suggest that companies are now using AI in more parts of the business. Half of respondents say their organizations have adopted AI in two or more business functions, up from less than a third of respondents in 2023 (Exhibit 2).

Gen AI adoption is most common in the functions where it can create the most value

Most respondents now report that their organizations—and they as individuals—are using gen AI. Sixty-five percent of respondents say their organizations are regularly using gen AI in at least one business function, up from one-third last year. The average organization using gen AI is doing so in two functions, most often in marketing and sales and in product and service development—two functions in which previous research  determined that gen AI adoption could generate the most value 3 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023. —as well as in IT (Exhibit 3). The biggest increase from 2023 is found in marketing and sales, where reported adoption has more than doubled. Yet across functions, only two use cases, both within marketing and sales, are reported by 15 percent or more of respondents.

Gen AI also is weaving its way into respondents’ personal lives. Compared with 2023, respondents are much more likely to be using gen AI at work and even more likely to be using gen AI both at work and in their personal lives (Exhibit 4). The survey finds upticks in gen AI use across all regions, with the largest increases in Asia–Pacific and Greater China. Respondents at the highest seniority levels, meanwhile, show larger jumps in the use of gen Al tools for work and outside of work compared with their midlevel-management peers. Looking at specific industries, respondents working in energy and materials and in professional services report the largest increase in gen AI use.

Investments in gen AI and analytical AI are beginning to create value

The latest survey also shows how different industries are budgeting for gen AI. Responses suggest that, in many industries, organizations are about equally as likely to be investing more than 5 percent of their digital budgets in gen AI as they are in nongenerative, analytical-AI solutions (Exhibit 5). Yet in most industries, larger shares of respondents report that their organizations spend more than 20 percent on analytical AI than on gen AI. Looking ahead, most respondents—67 percent—expect their organizations to invest more in AI over the next three years.

Where are those investments paying off? For the first time, our latest survey explored the value created by gen AI use by business function. The function in which the largest share of respondents report seeing cost decreases is human resources. Respondents most commonly report meaningful revenue increases (of more than 5 percent) in supply chain and inventory management (Exhibit 6). For analytical AI, respondents most often report seeing cost benefits in service operations—in line with what we found last year —as well as meaningful revenue increases from AI use in marketing and sales.

Inaccuracy: The most recognized and experienced risk of gen AI use

As businesses begin to see the benefits of gen AI, they’re also recognizing the diverse risks associated with the technology. These can range from data management risks such as data privacy, bias, or intellectual property (IP) infringement to model management risks, which tend to focus on inaccurate output or lack of explainability. A third big risk category is security and incorrect use.

Respondents to the latest survey are more likely than they were last year to say their organizations consider inaccuracy and IP infringement to be relevant to their use of gen AI, and about half continue to view cybersecurity as a risk (Exhibit 7).

Conversely, respondents are less likely than they were last year to say their organizations consider workforce and labor displacement to be relevant risks and are not increasing efforts to mitigate them.

In fact, inaccuracy— which can affect use cases across the gen AI value chain , ranging from customer journeys and summarization to coding and creative content—is the only risk that respondents are significantly more likely than last year to say their organizations are actively working to mitigate.

Some organizations have already experienced negative consequences from the use of gen AI, with 44 percent of respondents saying their organizations have experienced at least one consequence (Exhibit 8). Respondents most often report inaccuracy as a risk that has affected their organizations, followed by cybersecurity and explainability.

Our previous research has found that there are several elements of governance that can help in scaling gen AI use responsibly, yet few respondents report having these risk-related practices in place. 4 “ Implementing generative AI with speed and safety ,” McKinsey Quarterly , March 13, 2024. For example, just 18 percent say their organizations have an enterprise-wide council or board with the authority to make decisions involving responsible AI governance, and only one-third say gen AI risk awareness and risk mitigation controls are required skill sets for technical talent.

Bringing gen AI capabilities to bear

The latest survey also sought to understand how, and how quickly, organizations are deploying these new gen AI tools. We have found three archetypes for implementing gen AI solutions : takers use off-the-shelf, publicly available solutions; shapers customize those tools with proprietary data and systems; and makers develop their own foundation models from scratch. 5 “ Technology’s generational moment with generative AI: A CIO and CTO guide ,” McKinsey, July 11, 2023. Across most industries, the survey results suggest that organizations are finding off-the-shelf offerings applicable to their business needs—though many are pursuing opportunities to customize models or even develop their own (Exhibit 9). About half of reported gen AI uses within respondents’ business functions are utilizing off-the-shelf, publicly available models or tools, with little or no customization. Respondents in energy and materials, technology, and media and telecommunications are more likely to report significant customization or tuning of publicly available models or developing their own proprietary models to address specific business needs.

Respondents most often report that their organizations required one to four months from the start of a project to put gen AI into production, though the time it takes varies by business function (Exhibit 10). It also depends upon the approach for acquiring those capabilities. Not surprisingly, reported uses of highly customized or proprietary models are 1.5 times more likely than off-the-shelf, publicly available models to take five months or more to implement.

Gen AI high performers are excelling despite facing challenges

Gen AI is a new technology, and organizations are still early in the journey of pursuing its opportunities and scaling it across functions. So it’s little surprise that only a small subset of respondents (46 out of 876) report that a meaningful share of their organizations’ EBIT can be attributed to their deployment of gen AI. Still, these gen AI leaders are worth examining closely. These, after all, are the early movers, who already attribute more than 10 percent of their organizations’ EBIT to their use of gen AI. Forty-two percent of these high performers say more than 20 percent of their EBIT is attributable to their use of nongenerative, analytical AI, and they span industries and regions—though most are at organizations with less than $1 billion in annual revenue. The AI-related practices at these organizations can offer guidance to those looking to create value from gen AI adoption at their own organizations.

To start, gen AI high performers are using gen AI in more business functions—an average of three functions, while others average two. They, like other organizations, are most likely to use gen AI in marketing and sales and product or service development, but they’re much more likely than others to use gen AI solutions in risk, legal, and compliance; in strategy and corporate finance; and in supply chain and inventory management. They’re more than three times as likely as others to be using gen AI in activities ranging from processing of accounting documents and risk assessment to R&D testing and pricing and promotions. While, overall, about half of reported gen AI applications within business functions are utilizing publicly available models or tools, gen AI high performers are less likely to use those off-the-shelf options than to either implement significantly customized versions of those tools or to develop their own proprietary foundation models.

What else are these high performers doing differently? For one thing, they are paying more attention to gen-AI-related risks. Perhaps because they are further along on their journeys, they are more likely than others to say their organizations have experienced every negative consequence from gen AI we asked about, from cybersecurity and personal privacy to explainability and IP infringement. Given that, they are more likely than others to report that their organizations consider those risks, as well as regulatory compliance, environmental impacts, and political stability, to be relevant to their gen AI use, and they say they take steps to mitigate more risks than others do.

Gen AI high performers are also much more likely to say their organizations follow a set of risk-related best practices (Exhibit 11). For example, they are nearly twice as likely as others to involve the legal function and embed risk reviews early on in the development of gen AI solutions—that is, to “ shift left .” They’re also much more likely than others to employ a wide range of other best practices, from strategy-related practices to those related to scaling.

In addition to experiencing the risks of gen AI adoption, high performers have encountered other challenges that can serve as warnings to others (Exhibit 12). Seventy percent say they have experienced difficulties with data, including defining processes for data governance, developing the ability to quickly integrate data into AI models, and an insufficient amount of training data, highlighting the essential role that data play in capturing value. High performers are also more likely than others to report experiencing challenges with their operating models, such as implementing agile ways of working and effective sprint performance management.

About the research

The online survey was in the field from February 22 to March 5, 2024, and garnered responses from 1,363 participants representing the full range of regions, industries, company sizes, functional specialties, and tenures. Of those respondents, 981 said their organizations had adopted AI in at least one business function, and 878 said their organizations were regularly using gen AI in at least one function. To adjust for differences in response rates, the data are weighted by the contribution of each respondent’s nation to global GDP.

Alex Singla and Alexander Sukharevsky  are global coleaders of QuantumBlack, AI by McKinsey, and senior partners in McKinsey’s Chicago and London offices, respectively; Lareina Yee  is a senior partner in the Bay Area office, where Michael Chui , a McKinsey Global Institute partner, is a partner; and Bryce Hall  is an associate partner in the Washington, DC, office.

They wish to thank Kaitlin Noe, Larry Kanter, Mallika Jhamb, and Shinjini Srivastava for their contributions to this work.

This article was edited by Heather Hanselman, a senior editor in McKinsey’s Atlanta office.

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Legal Dictionary

The Law Dictionary for Everyone

Judicial Review

In the United States, the courts have the ability to scrutinize statutes, administrative regulations, and judicial decisions to determine whether they violate provisions of existing laws, or whether they violate the individual State or United States Constitution . A court having judicial review power, such as the United States Supreme Court, may choose to quash or invalidate statutes, laws, and decisions that conflict with a higher authority. Judicial review is a part of the checks and balances system in which the judiciary branch of the government supervises the legislative and executive branches of the government. To explore this concept, consider the following judicial review definition.

Definition of Judicial Review

• Noun. The power of the U.S. Supreme Court to determine the constitutionality of laws, judicial decisions, or acts of a government official.

Origin:  Early 1800s  U.S. Supreme Court

What is Judicial Review

While the authors of the U.S. Constitution were unsure whether the federal courts should have the power to review and overturn executive and congressional acts, the Supreme Court itself established its power of judicial review in the early 1800s with the case of Marbury v. Madison (5 U.S. (1 Cranch) 137, 2L Ed. 60). The case arose out of the political wrangling that occurred in the weeks before President John Adams left office for Thomas Jefferson.

The new President and Congress overturned the many judiciary appointments Adams had made at the end of his term, and overturned the Congressional act that had increased the number of Presidential judicial appointments. For the first time in the history of the new republic , the Supreme Court ruled that an act of Congress was unconstitutional. By asserting that it is emphatically the judicial branch ’s province to state and clarify what the law actually is, the court assured its position and power over judicial review.

Topics Subject to Judicial Review

The judicial review process exists to help ensure no law enacted, or action taken, by the other branches of government , or by lower courts, contradicts the U.S. Constitution. In this, the U.S. Supreme Court is the “supreme law of the land.” Individual State Supreme Courts have the power of judicial review over state laws and actions, charged with making rulings consistent with their state constitutions. Topics that may be brought before the Supreme Court may include:

• Executive actions or orders made by the President
• Regulations issued by a government agency
• Legislative actions or laws made by Congress
• State and local laws
• Judicial error

Judicial Review Example Cases

Throughout the years, the Supreme Court has made many important decisions on issues of civil rights , rights of persons accused of crimes, censorship , freedom of religion, and other basic human rights.  Below are some notable examples.

Miranda v. Arizona (1966)

The history of modern day Miranda rights begins in 1963, when Ernesto Miranda was arrested for, and interrogated about, the rape of an 18-year-old woman in Phoenix, Arizona. During the lengthy interrogation, Miranda, who had never requested a lawyer , confessed and was later convicted of rape and sent to prison . Later, an attorney appealed the case, requesting judicial review by the Supreme Court, claiming that Ernesto Miranda’s rights had been violated, as he never knew he didn’t have to speak at all with the police.

The Supreme Court, in 1966, overturned Miranda’s conviction, and the court ruled that all suspects must be informed of their right to an attorney, as well as their right to say nothing, before questioning by law enforcement. The ruling declared that any statement, confession, or evidence obtained prior to informing the person of their rights would not be admissible in court. While Miranda was retried and ultimately convicted again, this landmark Supreme Court ruling resulted in the commonly heard “Miranda Rights” read to suspects by police everywhere in the country.

Weeks v. United States (1914)

Federal agents, suspecting Fremont Weeks was distributing illegal lottery chances through the U.S. mail system, entered and searched his home, taking some of his personal papers with them. The agents later returned to Weeks’ house to collect more evidence, taking with them letters and envelopes from his drawers. Although the agents had no search warrant , seized items were used to convict Weeks of operating an illegal gambling ring.

The matter was brought to judicial review before the U.S. Supreme Court to decide whether Weeks’ Fourth Amendment right to be secure from unreasonable search and seizure , as well as his Fifth Amendment right to not testify against himself, had been violated. The Court, in a unanimous decision, ruled that the agents had unlawfully searched for, seized, and kept Weeks’ letters. This landmark ruling led to the “ Exclusionary Rule ,” which prohibits the use of evidence obtained in an illegal search in trial .

Plessey v. Ferguson (1869)

Having been arrested and convicted for violating the law requiring “Blacks” to ride in separate train cars, Homer Plessey appealed to the Supreme Court, stating the so called “Jim Crow” laws violated his 14th Amendment right to receive “equal protection under the law.” During the judicial review, the state argued that Plessey and other Blacks were receiving equal treatment, but separately. The Court upheld Plessey’s conviction, and ruled that the 14th Amendment guarantees the right to “equal facilities,” not the “same facilities.” In this ruling, the Supreme Court created the principle of “ separate but equal .”

United States v. Nixon (“Watergate”) (1974)

During the 1972 election campaign between Republican President Richard Nixon and Democratic Senator George McGovern, the Democratic headquarters in the Watergate building was burglarized. Special federal prosecutor Archibald Cox was assigned to investigate the matter, but Nixon had him fired before he could complete the investigation. The new prosecutor obtained a subpoena ordering Nixon to release certain documents and tape recordings that almost certainly contained evidence against the President.

Nixon, asserting an “absolute executive privilege” regarding any communications between high government officials and those who assist and advise them, produced heavily edited transcripts of 43 taped conversations, asking in the same instant that the subpoena be quashed and the transcripts disregarded. The Supreme Court first ruled that the prosecutor had submitted sufficient evidence to obtain the subpoena, then specifically addressed the issue of executive privilege. Nixon’s declaration of an “absolute, unqualified Presidential privilege of immunity from judicial process under all circumstances,” was flatly rejected. In the midst of this “Watergate scandal,” Nixon resigned from office just 15 days later, on August 9, 1974.

The Authority Behind Judicial Review

Interestingly, Article III of the U.S. Constitution does not specifically give the judicial branch the authority of judicial review. It states specifically:

“The judicial Power shall extend to all Cases, in Law and Equity, arising under this Constitution, the Laws of the United States, and Treaties made, or which shall be made, under their Authority.”

This language clearly does not state whether the Supreme Court has the power to reverse acts of Congress. The power of judicial review has been garnered by assumption of that power:

• Power From the People . Alexander Hamilton, rather than attempting to prove that the Supreme Court had the power of judicial review, simply assumed it did. He then focused his efforts on persuading the people that the power of judicial review was a positive thing for the people of the land.
• Constitution Binding on Congress . Hamilton referred to the section that states “No legislative act, therefore, contrary to the Constitution, can be valid,” and pointed out that judicial review would be needed to oversee acts of Congress that may violate the Constitution.
• The Supreme Court’s Charge to Interpret the Law . Hamilton observed that the Constitution must be seen as a fundamental law, specifically stated to be the supreme law of the land. As the courts have the distinct responsibility of interpreting the law, the power of judicial review belongs with the Supreme Court.

What Cases are Eligible for Judicial Review

Although one party or another is going to be unhappy with a judgment or verdict in most court cases, not every case is eligible for appeal . In fact, there must be some legal grounds for an appeal, primarily a reversible error in the trial procedures, or the violation of Constitutional rights . Examples of reversible error include:

• Jurisdiction . The court wrongly assumes jurisdiction in a case over which another court has exclusive jurisdiction.
• Admission or Exclusion of Evidence . The court incorrectly applies rules or laws to either admit or deny the admission of certain vital evidence in the case. If such evidence proves to be a key element in the outcome of the trial, the judgment may be reversed on appeal.
• Jury Instructions . If, in giving the jury instructions on how to apply the law to a specific case, the judge has applied the wrong law, or an inaccurate interpretation of the correct law, and that error is found to have been prejudicial to the outcome of the case, the verdict may be overturned on judicial review.

Related Legal Terms and Issues

• Executive Privilege – The principle that the President of the United States has the right to withhold information from Congress, the courts, and the public, if it jeopardizes national security, or because disclosure of such information would be detrimental to the best interests of the Executive Branch .
• Jim Crow Laws – The legal practice of racial segregation in many states from the 1880s through the 1960s. Named after a popular black character in minstrel shows, the Jim Crow laws imposed punishments for such things as keeping company with members of another race, interracial marriage, and failure of business owners to keep white and black patrons separated.
• Judicial Decision – A decision made by a judge regarding the matter or case at hand.
• Overturn – To change a decision or judgment so that it becomes the opposite of what it was originally.
• Search Warrant – A court order that authorizes law enforcement officers or agents to search a person or a place for the purpose of obtaining evidence or contraband for use in criminal prosecution.

Meaning Therapy: An Integrative and Positive Existential Psychotherapy

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• Published: 25 December 2009
• Volume 40 , pages 85–93, ( 2010 )

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Meaning Therapy, also known as meaning-centered counseling and therapy, is an integrative, positive existential approach to counseling and psychotherapy. Originated from logotherapy, Meaning Therapy employs personal meaning as its central organizing construct and assimilates various schools of psychotherapy to achieve its therapeutic goal. Meaning Therapy focuses on the positive psychology of making life worth living in spite of sufferings and limitations. It advocates a psycho-educational approach to equip clients with the tools to navigate the inevitable negatives in human existence and create a preferred future. The paper first introduces the defining characteristics and assumptions of Meaning Therapy. It then briefly describes the conceptual frameworks and the major intervention strategies. In view of Meaning Therapy’s open, flexible and integrative approach, it can be adopted either as a comprehensive method in its own right or as an adjunct to any system of psychotherapy.

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Wong, P.T.P. Meaning Therapy: An Integrative and Positive Existential Psychotherapy. J Contemp Psychother 40 , 85–93 (2010). https://doi.org/10.1007/s10879-009-9132-6

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Psychotherapy and the Meaning of Life

Finding new meaning may be at the heart of change in therapy..

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Different psychotherapies have traditionally focused on an active collaboration between therapist and client so as to foster a reconstruction of the meaning of the client's suffering, self-narrative, and life. Meaning has always been a central axis of therapies, which are not limited to an exclusive focus on symptomatic improvement—understood as a change in apparently isolated behaviours, cognitions, or emotions—as important as that is.

The historically known importance of this dimension of searching for and attributing meaning to experience has been highlighted by research. In one of these studies, Diaz, Horton, & Malloy (2014) investigated how adult attachment style (secure vs. insecure) and two dimensions of spirituality (existential purpose/meaning of life and religious well-being or perceived relationship with God) were associated with depressive symptoms in a group of patients who were being treated for their drug addiction . The researchers found that secure attachment style and high levels of existential purpose and meaning in life were significantly related to low levels of depressive symptoms, and, thus, existential purpose and meaning in life were strong predictors of depressive symptoms. In addition, their results indicated that fostering the creative talent of the participants (for example, through creative writing or painting workshops), providing them with the opportunity to carry out tasks of service to others, and fostering connection with their core values ​​through introspective and meditative practices helped them build that existential purpose and meaning in life that contributed to their recovery process.

Another study (Dezutter, Luyckx, & Wachholtz, 2015) showed that the presence of meaning was an important predictor of well-being and adaptation to chronic pain in a sample of 273 patients. In addition, the achievement of meaning in life has been associated with reduced levels of anxiety (Shiah, Chang, Chiang, Lin, & Tam, 2015), the maintenance of healthy habits of physical activity and eating in adolescents (Brassai, Piko, & Stege, 2015), the healthy adaptation to grief and loss (Neimeyer, 2014) and, in general, to a great variety of adaptive or reconstructive processes in human life.

In fact, meaning reconstruction could well be considered a common factor to different forms of psychotherapy , and each of them is very likely to promote it in their clients, albeit in different ways—and even "despite" the fact that some therapies do not attempt it explicitly because they don’t consider it a therapeutic factor in itself. Thus, for example, behavioral therapies promote clients' processes of meaning reconstruction through their call to action and behavioral change ( new meanings through action ); Rogerian therapy through the use of the therapeutic relationship itself given the climate of empathy, acceptance, and congruence that is created ( new meanings through compassionate reflection ); psychodynamic therapy through the therapist's interpretations and the patient's intrapsychic processes ( new meanings through insight ); the systemics through the provision of new relational experiences ( new meanings through new ways of relating ); and cognitive therapies through the identification and restructuring of problematic cognitive processes ( new meanings through new ways of thinking ).

In other words, it is perfectly acceptable that there may be different preferential access routes to the processes of meaning reconstruction. In fact, it is quite coherent; if this was not so, all human life (at least from a psychological point of view) would depend on a single dimension—be it emotional, cognitive, behavioral, or relational. It would be as if evolution had made us extremely vulnerable to invalidation by gambling everything on a single card.

Now, how does achieving an acceptable meaning for our personal problem or difficulty contribute to our coping and wellbeing? A classic study with university students may shed light on this. Wilson, Damiani, & Shelton (2002) divided 40 Duke University freshmen who were having academic achievement problems into two groups: one intervention and one control. Those in the intervention group were exposed to information that showed that it is normal for a first-year student to have some adjustment difficulties: specifically, they saw videos of students with higher grades explaining how their grades had improved as they adjusted to University. The goal was to achieve a narrative change: instead of thinking of them as failures not fit for university, the experience of their classmates encouraged them to construct their situation as temporary, and the product of a provisional imbalance that would disappear as they adapt.

The results of the intervention were surprising. Students in the intervention group scored better on a sample test almost immediately. However, the long-term results were the most impressive: students who had been led to modify their personal stories improved their grade point average, and the dropout rate among them during the following course (5%) was significantly lower than that of those who did not receive information (20%).

What changed in them? Looking strictly at the “intervention,” it was not focused on them acquiring skills or abilities, nor on understanding their difficulties in a biographical, emotional, or relational past context. It focused on giving them a different meaning, whose implications went from being catastrophic and decisive to a more hopeful future , one more open to change, a future in which they were no longer victims but protagonists.

It is very possible that in all the cases mentioned in this post ( depression , chronic pain, anxiety, self-care, grief, academic performance) the problem is not only "the problem", but the position of helplessness, emptiness, and unpredictability in which one is placed by the problem. Attributing meaning to, or making sense of, the difficulties one experiences entails locating them in an ongoing narrative, a location that makes them intelligible (without forgetting that they can be very painful) and, in a profound sense, endurable. That is perhaps the process that initiates and maintains all the other human change processes that allow us to move forward, to keep elaborating the ongoing narrative that constitutes our own life and, in the best of cases, to close a chapter and start a new one.

—Luis Botella, Ph.D., professor of psychotherapy at FPCEE Blanquerna, Ramon Llull University, Barcelona (Spain)

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To find a therapist near you, visit the Psychology Today Therapy Directory .

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Brassai, L., Piko, B.F. & Steger, M.F. (2011). Meaning in Life: Is It a Protective Factor for Adolescents’ Psychological Health? International Journal of Behavioral Medicine, 18 , 44–51, https://doi.org/10.1007/s12529-010-9089-6

Dezutter, J., Luyckx, K. & Wachholtz, A. (2015). Meaning in life in chronic pain patients over time: associations with pain experience and psychological well-being. Journal of Behavioral Medicine, 38 , 384–396 https://doi.org/10.1007/s10865-014-9614-1

Diaz, N., Horton, G., & Malloy, T. (2014). Attachment Style, Spirituality, and Depressive Symptoms Among Individuals in Substance Abuse Treatment. Journal of Social Service Research, 40 :3, 313-324, DOI: 10.1080/01488376.2014.896851

Neimeyer R.A. (2015) Meaning in Bereavement. In: Anderson R. (eds) World Suffering and Quality of Life. Social Indicators Research Series, vol 56. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-9670-59

Shiah, YJ., Chang, F., Chiang, SK. et al. (2015). Religion and Health: Anxiety, Religiosity, Meaning of Life and Mental Health. Journal of Religion and Health, 54 , 35–45, https://doi.org/10.1007/s10943-013-9781-3

Wilson, T. D., Damiani, M., & Shelton, N. (2002). Improving the academic performance of college students with brief attributional interventions. In J. Aronson (Ed.), Improving academic achievement: Impact of psychological factors on education (pp. 89–108). New York, NY: Academic Press.

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Psychotherapy: A World of Meanings

Despite a wealth of findings that psychotherapy is an effective psychological intervention, the principal mechanisms of psychotherapy change are still in debate. It has been suggested that all forms of psychotherapy provide a context which enables clients to transform the meaning of their experiences and symptoms in such a way as to help clients feel better, and function more adaptively. However, psychotherapy is not the only health care intervention that has been associated with “meaning”: the reason why placebo has effects has also been proposed to be a “meaning response.” Thus, it has been argued that the meaning of treatments has a central impact on beneficial (and by extension, negative) health-related responses. In light of the strong empirical support of a contextual understanding of psychotherapy and its effects, the aim of this conceptual analysis is to examine the role of meaning and its transformation in psychotherapy—in general—and within three different, commonly used psychotherapy modalities.

Introduction

Psychotherapy is an effective psychological intervention for a multitude of psychological, behavioral, and somatic problems, symptoms, and disorders and thus rightfully considered as a main approach in mental and somatic health care management ( Prince et al., 2007 ; Goldfried, 2013 ). But despite the wealth of empirical findings, the principal mechanisms of psychotherapy change are still in debate ( Wampold and Imel, 2015 ). Two rival models have been contested ever since the very beginning of psychotherapy research, when some 80 years ago Saul Rosenzweig wondered, “whether the factors alleged to be operating in a given therapy are identical with the factors that actually are operating and whether the factors that actually are operating in several different therapies may not have much more in common than have the factors alleged to be operating.” ( Rosenzweig, 1936 , p. 412). Rosenzweig questioned the common understanding of psychotherapy, in which it is assumed that specific techniques have specific effects. This proposition was later elaborated through the work of Jerome Frank who argued that all forms of psychotherapy provide a context which enables patients to transform the meaning of their experiences and symptoms in such a way as to help them to feel better, function more favorably, and think more adaptively ( Frank, 1986 ).

Interestingly and central to this paper, psychotherapy is not the only psychological intervention which has been associated with meaning. Following the assumption that “meaning responses are always there” ( Moerman, 2006 , p. 234)—i.e., in any medical and psychological treatment—the attribution of meaning has also been considered as an overarching mechanism for those treatment effects which placebo controls for in clinical trials. Thus, the attribution of a therapeutic meaning to a given intervention has a central impact on health-related responses ( Barrett et al., 2006 ).

The contextual model of psychotherapy remains topical ( Kirsch et al., 2016 ), and also controversial ( Marcus et al., 2014 ). The model has been developed to propose that it is the “common factors” (e.g., client-therapist relationship, clients’ expectations, trust, understanding, and expertise) across different versions of psychotherapy that explain their effectiveness (for details, see Wampold et al. (2011) ). The hypothesis for the general equivalence of various forms of psychotherapies is usually referred to as the dodo bird conjecture ( Rosenzweig, 1936 ). Hence, the contextual model of psychotherapy is markedly in contrast with the long-held assumption that specific methods are at the root of psychotherapy’s effects. The assumption that psychotherapy’s effects can be reduced to incidental—or contextual—constituents, which are typically called common or unspecific factors, has been a constant in psychotherapy research ( Luborsky et al., 2002 ; Gaab et al., 2016 ) but at least in terms of empirical evidence, there is sound reason and accumulating empirical support for a contextual understanding of psychotherapy ( Wampold and Imel, 2015 ). For example, a number of meta-analyses showed that various bona fide psychotherapies, i.e., therapies with a clear treatment rationale but with very different underlying theories, aims, and methods appear to be equally effective ( Spielmans et al., 2007 ; Cuijpers et al., 2008 ; Barth et al., 2013 ; Frost et al., 2014 ). In addition, opposing treatment approaches with the same treatment rationale have shown to be equally effective in a trial on clients with panic disorder ( Kim et al., 2012 ) as much as similar treatments provided with opposing treatment rationales have shown to differ in their effects ( Tondorf et al., 2017 ).

Building on the strong empirical support for a contextual understanding of psychotherapy ( Wampold and Imel, 2015 ), which proposes the transformation of meaning as its central mechanisms, the aim of this conceptual analysis is to examine the role of meaning and its transformation in psychotherapy in general and in three different and commonly used psychotherapy approaches.

In Search of a New Meaning

The main incentive to undergo a psychotherapy treatment is to change the general level of functioning, as well as to reduce the symptoms of suffering ( Strong and Matross, 1973 ). Clients’ belief that they are unable or incapable of solving disturbing problems contributes to demoralization and feelings of confusion, despair, and incompetence ( Vissers et al., 2010 ) or as Frank (1986) put it: “Often an important feature of demoralization is a sense of confusion resulting from the client’s inability to make sense out of his experiences or to control them, leading to the commonly expressed fear of going insane” (p. 341). This demoralization is not only a shared aspect of various psychological disorders, but can also be considered as a starting point for change in psychotherapy. Therapeutic change is thereby accompanied by clients “working through” their problems, gaining insight, achieving personal fulfillment, and becoming self-actualized, eventually transforming their problems and symptoms, self-perception, and experiences with their social environment ( Evans, 2013 ; Krause et al., 2015 ).

Frank (1986) stated that psychotherapy seeks to help clients to transform the meanings of their problems and symptoms and to overcome confusion with newly acquired clarity, i.e., by offering a narrative that links symptoms with hypothesized causes and providing a collaborative procedure for overcoming the suffering. Likewise, Wampold (2007) defined the core of psychotherapy in the transformation of non-adaptive explanations for their problems into new and more adaptive ones. Also, Dan Moerman ( Moerman, 2002 ) stated that “it sounds reasonable to me to say that psychotherapy evokes meaning responses” (p. 94) and that psychotherapy supports clients to create their stories and myths, although therapists are not considered a mandatory requirement for this ( Moerman, 2002 ). It should be noted that other mechanisms underlying positive response to psychotherapy have been proposed, e.g., reward mechanisms in psychotherapy ( Northoff and Boeker, 2006 ; Panksepp and Solms, 2012 ).

Considering processes of change in diverse interventions, narratives are thought to be created in order to render the demoralization less painful and promote remoralization ( Moerman, 2002 ). In this perspective, the therapists help their clients to give new meanings to their experiences or stories they tell, the language they use, and the beliefs they have ( Shaw, 2010 ).

Similar processes have been proposed to underlie placebo responses, which are “most likely to occur when the meaning of the illness experience is altered in a positive direction” ( Brody, 2000 ). These beneficial changes in meaning occur when three core conditions are present, which again resemble those proposed in the context of psychotherapy: (1) the clients feel listened to and receive a satisfactory, coherent explanation of their mental suffering and demoralization; (2) the client feels care and concern from the therapist; and (3) the clients feel an enhanced sense of mastery and control over their mental suffering (i.e., remoralization). A direct implementation can be seen in so-called narrative therapies, which are defined as “an approach that focuses on client stories with the goal of challenging existing meaning systems and creating more functional ones” ( Kropf and Tandy, 1998 ). Narrative approaches have come to a central role in systemic family therapy ( Carr, 1998 ; Wallis et al., 2011 ), emphasizing the role of language and how it affects the way clients frame their ideas of self and identity, while the therapist directly deals with clients’ concerns and the meaning of the worlds they live in ( Besley, 2002 ). Furthermore, it has been assumed that relying on the clients’ individual narratives is more significant than focusing on a pathological psychiatric diagnosis ( Gysin-Maillart et al., 2016 ). Of course, narrative therapies should not be mistaken as the exception of (dodo) rule, i.e., to be instances of “specific” therapies, but rather as possibilities to operationalize the rule in real life, i.e., to employ meaning processes in psychotherapy. Accordingly, it has been shown that meaning-making through language enhances clients’ well-being after a traumatic experience—which mainly stems from the connection, abstraction, and reflection of the whole experience ( Freda and Martino, 2015 ; Park et al., 2016 ).

Co-Construction of Narratives

To bring about these meaning transformations, psychotherapists mostly rely “on the use of words to form attitudes or induce actions” ( Frank, 1986 ). The overarching definition of a narrative is as a sequence of actions and events that involves a certain number of human beings as characters or actors ( Bruner, 1990 ). However, narratives differ from conventional discourse forms in variety of ways as narratives have an inherent sequentiality which is more than a just chronological sequence of lived experiences as it links the past to the present and future ( Bruner, 1990 ). A narrative creates a coherent whole out of a sequence of events ( Mattingly, 1994 ). In order to report an experience in a meaningful way, the protagonists not only focus on overt characteristics, but also reflect on their beliefs and feelings and how these are connected to their personal life in general ( Ochs and Capps, 1996 ). In regard to a broader social context, Justman (2011) argues that any information about a given intervention has an influence on the experience of clients receiving the intervention, which of course is particularly applicable for any form of psychotherapy.

In this understanding, any psychotherapy alleviates the symptoms of a target illness through meaning transformation. Thus, the relationship between narrative and illness—understood as the subjective experience of a given pathological process and their embedment in social context ( Engel, 1977 )—should briefly be exemplified. An illness narrative is defined as the important channel through which the meaning of an illness is created ( Kleinman, 1988 ). Thus, illness narratives do not merely reflect an illness experience, but they have been shown to be clinically relevant as they significantly impact on health behaviors and coping strategies as well as treatment outcomes ( Broadbent et al., 2004 ; Horne et al., 2007 ; Frenkel, 2008 ; Galli et al., 2010 ).

Furthermore, narratives are interdependent with the social context, so that therapists should use “images from the same sensory modality as that of the patient’s own imagery” ( Frank, 1986 ). The alternative narratives which are provided to the client in order to offer new and adaptive perspectives should be different but not too far off the client’s general beliefs ( Wampold, 2007 ) as much as exploring the clients’ narrative through attentive listening—both considered as key factors of healing processes ( Egnew, 2005 ; Mauksch et al., 2008 )—as they allow the therapist to reformulate and interpret the perceived meanings in a way that the clients can connect them with their personal conception of the world on the background of their beliefs and culture ( Strupp, 1986 ). Considering narratives in the psychotherapeutic encounter, the importance of the therapist’s and client’s co-construction of the narrative has been considered as a significant element of psychotherapy ( Brody, 1994 ) as jointly developed narratives significantly contribute to new forms of self-understanding and of being in the world ( Levitt et al., 2016 ). According to Brody (1994) , a shorter form of the client’s possible plea to the psychotherapist might be, “My story is broken; can you help me fix it?” (p. 85). Recovery in this understanding includes a deepening of a client’s experience and the development of a more comprehensive and coherent personal narrative ( Lysaker et al., 2011 ).

Truth Matters?

As outlined, the transformation of non-adaptive narratives into more adaptive ones is central to the contextual understanding of psychotherapy. This raises the question of the relationship between the narratives, i.e., their quality to induce subjective understanding, and the “real world,” i.e., the actual facts of a client’s life and actual causes of symptoms ( Kendler et al., 2011 ). Importantly, two kinds of narratives should be distinguished. First is the narrative behind the therapeutic approach, i.e., the healing narrative. Frank reasoned “that the chief criterion of the truth of any psychotherapeutic formulation is its plausibility” ( Frank, 1986 ). Hence, the explanation for why the treatment works should be plausible for both the therapist and the client. When the healing narrative is credible for the clients, they will discern and pick up on the aims and goals of therapy. Common factors associated with the healing narrative are for example the provision of an explanation for the client’s problems, therapeutic actions that are consistent with the explanation, as well as education ( Kirsch et al., 2016 ).

A second narrative is the client narrative that may emerge from therapy. This kind of narrative amounts to the actual change in the personal story, i.e., explanations that clients in therapy come to acquire about their own personality and reasons for their suffering. Common factors related with the client narrative are insight, corrective emotional experience, emotion regulation, and mindfulness among others ( Kirsch et al., 2016 ). Forming personal experiences into a narrative has further been associated with both physical and mental well-being and, accordingly, “psychotherapy is a more formal venue that often involves putting together a story” ( Pennebaker and Seagal, 1999 ). While this concept resonates with the now sadly predominant concept of “truthiness” (i.e., the quality of stating concepts or facts one wishes or believes to be true, rather than concepts or facts known to be true) in everyday life ( Metcalf, 2005 ), the understanding of plausibility in the context of a narrative is basically subjunctive or put otherwise: something is subjectively perceived to be possible ( Kleinman, 1988 ; Bruner, 1990 ). Further, this subjunctivity emphasizes that the anticipated future course is indispensably reported with some level of uncertainty, thus “to make a story good, it would seem, you must make it somewhat uncertain, somehow open to variant readings, rather subject to the vagaries of intentional states, undermined” ( Bruner, 1990 ). Likewise, Frank (1986) pointed out that “life histories do not provide adequate causal explanations of clients’ symptoms” (p. 343) and Jopling notes that “insights such as these may strike clients as entirely plausible and coherent, but neither plausibility nor coherence are, in themselves, a guarantee that the insights are true and that they fit the facts” ( Jopling, 2011 ). This corresponds with the idea that a client narrative emphasizes possibilities rather than predefined certainties ( Bruner, 2004 ) and that it not only copies reality as it is, but gives meaning to it through language ( Bruner, 1990 ). In turn, constructing the reality according to own beliefs and experiences affects as well as constitutes one’s self-perception. Accordingly, a client narrative is not only considered a personal report, but it also creates the identity of the story-teller ( Ricoeur, 1991 ). The self is reformed, which means that narrative and self are actually inseparable ( Ochs and Capps, 1996 ).

With these considerations in mind, the necessity of truth of an adaptive explanation for the client’s healing process comes into question. In this regard, it has been assumed that it might not be the truth itself that makes a narrative meaningful, yet rather its plausibility and “the extent to which a client is convinced by it” ( Frank, 1986 ). A plausible narrative for a mental disorder or a therapeutic change, respectively, invokes new information and is related to previous explanatory structures and networks of a client, when the new explanation is not too divergent from the previous one and takes a client’s perception of the world into account ( Wampold, 2007 ). Likewise, for clients who accept the treatment rationale, psychotherapeutic success occurs more quickly and psychotherapy outcomes are significantly better than for those who do not agree with the treatment rationale ( Addis and Jacobson, 2000 ; Overholser et al., 2010 ). However, the position that truth of a narrative is not the prerequisite for its meaningfulness does of course and in no way preclude psychotherapy and psychotherapists from the ethical obligations to respect clients’ autonomy. First, clients should not be deceived by providing false, but plausible narratives under any circumstances. Second, therapists should be aware to not withhold proven but possible implausible evidence about psychotherapy and psychotherapy change ( Blease et al., 2016 ; Gaab et al., 2016 ; Trachsel and Gaab, 2016 ).

Meaning Transformation in Psychotherapeutic Schools

Each psychotherapeutic school relies on a specific treatment theory, which addresses the connection between symptoms and hypothesized causes, as well as the process of therapeutic change. This treatment theory defines which treatment constituents are to be considered characteristic and which incidental ( Grünbaum, 1981 ). Although the various therapy approaches not only differ substantially in their operationalization of their constituents, but also in assignment to be either characteristic or incidental (e.g., the therapeutic alliance, Flückiger et al. (2012) ), they explicitly or implicitly promote a meaningful transformation regarding how clients understand and cope with their problems and symptoms, which in turn affects their self-perception and the interaction with their social environment. In the following, this shall be exemplified on three psychotherapeutic approaches. We decided to focus on three prominent psychotherapeutic approaches, with no claim to be complete in terms of therapeutic theories and methods. The following arguments guided our decision: first, the chosen psychotherapy approaches differ substantially in their underlying treatment theory; second, we decided to not focus on the link between psychodynamic psychotherapy with the “narrative feature of psychotherapy ‘which may be’ its main therapeutic engine” (cited from Blease, 2015 , p. 178) since this has been discussed elsewhere ( Jopling, 2011 ; Blease, 2015 ); third, popular third wave approaches (e.g., dialectical behavior therapy or acceptance and commitment therapy) conceptualize cognitions and cognitive thought processes as a way of “private behavior” ( Hayes et al., 2006 ), focusing primarily on the function of cognitions ( Churchill et al., 2010 ). We assume that the reflections on cognitive therapies will exhibit at least some comparable inferences.

Cognitive Therapies

The cognitive approach is based on the assumptions that the cognitive representation of clients’ experiences influences how they respond, act, and feel and that humans have the potential to metacognitize, thus to observe and change their thoughts and beliefs through reflection and practice, resulting in a different perception of one’s symptoms, self, and social environment ( Beck, 1996 ). The process of transformation through metacognition is embedded in a caring, collaborative, and respectful therapeutic relationship ( Alford et al., 1998 ; DeRubeis et al., 2001 ; Dobson and Dozois, 2001 ; Beck, 2005 ) and therapists should be competent not only in technical but also in interpersonal skills ( Beck and Padesky, 1989 ; Gaston et al., 1998 ).

The cognitive approach was initially formulated as a treatment for depression; later, it became very popular as an approach for treating a multitude of other mental disorders including anxiety disorders and posttraumatic stress disorders. However, even from its early days, reception to cognitive therapy included the criticisms that the approach faced “formidable conceptual, methodological, and empirical difficulties” ( Coyne and Gotlib, 1983 ) and that “it has the force of a good story, and does not ask us to believe in any cognitive mechanism beyond those that have been familiar to playwrights and novelists for centuries.” ( Lang, 1988 ).

Interestingly, the conceptualization of clients’ cognitions soon developed from being a merely covert behavior or the result of erroneous information-processing to the notion that clients are constructors of their own representation of the world and that the reality is “a product of personal meanings that individuals create” ( Meichenbaum, 1993 ). As such the cognitive therapist “helps clients to construct narratives that fit their particular present circumstances, that are coherent, and that are adequate in capturing, and explaining their difficulties” ( Meichenbaum, 1993 ). Besides this kind of meaning, where the cognitive therapist and the client create meaningful narratives, there is also another kind: the meaningfulness or plausibility of the therapy itself. In an earlier publication, Don Meichenbaum—a major proponent of cognitive therapies—also addressed the supremacy of plausibility over validity stating that “although the theory (i.e., Schachter’s model of emotional arousal) and research upon which it is based have been criticized (…), the theory has an aura of plausibility that the clients tend to accept. The logic of the treatment plan is clear to clients in light of this conceptualization” ( Wampold and Imel, 2015 ).

Addressing the lack of differences in efficacy between cognitive and clearly non-cognitive treatments for panic disorder and the lack of a clear confirmation of the validity of underlying cognitive theories, Roth (2010) noted that “there is little doubt that therapists have been able to greatly help clients in spite of giving rationales that have turned out to be questionable or demonstrably false” ( Roth, 2010 ). In the same vein, it is interesting to note that although the hyperventilation theory (i.e., clients are instructed to counteract hyperventilation by breathing slowly and abdominally, which is expected to increase Pco₂) has been falsified as well as the suffocation false alarm theory (i.e., clients are thought to lower their Pco₂) is difficult to falsify ( Roth et al., 2005 ), treatments on the basis of these—interestingly opposing!—theories have been shown to be equally effective in the treatment of panic disorder ( Kim et al., 2012 ). As a solution of the ethical conundrum to provide effective therapies despite them being false or questionable, Roth (2010) referred to Williams James’ pragmatic approach ( James, 1896 ) and to “simply teach clients a practice that has prevented attacks in others (such as breathing control) but without its pseudoscientific rationale, asking clients to test whether that practice helps them as individuals.”

Systemic Therapy

Systemic therapy is based on the assumption that a system is constructed by shared representations of realities, building a consensus on how to interpret the internal and external environment ( Reiss and Olivieri, 1980 ) and that this collective perception is largely determined by the emotional experiences of the members of the given system. The pattern of meaning within a system is mediated by its use of language and its narrative tradition. Behaviors, symptoms, and expression of emotions are thus not considered as objective and independent entities, but rather as functional to the mutual relationships within a system and as constructed through the actions and communications of and between its members. Therefore, systemic therapy intends to change the shared patterns of meaning and definitions of realities in the context of the particular system, i.e., therapists aim to understand and accept the individual pattern of meaning as much as the systems’ narrative about their reality. Neutrality and unconditional therapeutic curiosity ( Cecchin, 1987 ), i.e., the therapist does not side or support individual members of a given system, are thought to encourage all involved members of a system to share ideas and problem perceptions, while subjective truths are appreciated in the same way. This attitude of neutrality is contrary to the idea that a system could be understood entirely, i.e., that “truth” exists, and thus attempts to explore the systems’ narratives ( Selvini et al., 1980 ).

The meaning-changing nature of systemic therapy shall be exemplified on the basis of a commonly used method in systematic therapy, the “genogram”, which consists of a structural diagram of a family’s generational relationship system using specific symbols for illustration ( Guerin and Pendagast, 1976 ). The “genogram” aims to unravel idiosyncratic perceptions, trigger the unfolding of shared narratives with a given system, and capture the communicative meaning of behavior, symptoms, or expression of emotions ( McGoldrick and Gerson, 1985 ). When relationship patterns become apparent and members of a given system are challenged to perceive reality by another perspective, this can result in new illness narratives and eventually new meanings ( Satir et al., 1991 ). Another approach in systemic therapy to change meaning is to reframe communication without changing its content ( Watzlawick et al., 2011 ). For example, the otherwise negatively and non-adaptive connoted behavior of acting-out is reframed as functional to make yourself heard in the context of a demanding and bullying school environment, thus transforming a formerly non-adaptive meaning of symptom into a new and more adaptive justification. Also, systemic therapy makes use of externalizing, i.e., to differentiate a problem and the identity of the client in order to enable a new context of meaning and to change the assumptions of what is driving and maintaining the problem ( White et al., 1990 ). According to De Shazer’ (1985) solution-focused approach, a system is viewed as having all resources that it needs for solving the problem but it is not using them currently. Thus, idiosyncratic meanings of a problem on the one hand are thought to underlie the presenting problems and on the other hand are also considered as the starting point for change: building new shared narratives involve all relevant members of the system and activate individual processes.

Person-Centered Therapy

The subjective experience of a person, i.e., the self-concept, is both the starting point as much as the therapeutic focus of the person-centered approach which is based on the principles of humanistic psychology. The person-centered approach originated in the works of Carl Rogers, who defined the necessary and sufficient condition for personality change ( Rogers, 1957 ). The self-concept is viewed as fluid and associated with changing idiosyncratic interpretations and attributions of subjective meanings. The driving force behind any change is the self-actualizing tendency for development, enhancement, and growth ( Rogers and Carmichael, 1951 ). Accordingly, a discrepancy between self-concept and the actual experience leads to incongruence, i.e., a state of tension and internal confusion, resembling Frank’s term demoralization ( Frank, 1986 ). This incongruence can either be the starting point for personality change and development or—in case of too large a discrepancy—be distorted, i.e., denied, biased, and not fully represented in experience.

The aim of person-centered therapy is congruence, i.e., to enable the clients to understand their own experiences and to be able to integrate them with their self-concept ( Rogers and Carmichael, 1951 ). A meaning transformation is understood as the clients revising their self-concept in a way to allow congruence with their experience ( Rogers, 1957 ). In this therapeutic process, the therapist is central and thus acknowledges the subjective experience of the client as much as specific techniques are only advocated when they “become a channel for communicating the essential conditions” (i.e., empathy, congruence and unconditional positive regard) (cited from Rogers, 1957 , p. 247). Thus, in person-centered therapy, the therapist and client construct a shared narrative as the therapist empathically understands the client’s inner representation of its experience and to carefully offer meanings to the client’s experience of which the client is scarcely aware ( Rogers, 1957 ).

Based on the contextual understanding of psychotherapy, we set out to examine the role and construction of meaning as a means to induce change in general and in three different psychotherapy approaches. The described psychotherapeutic approaches differ in their etiological assumptions and their therapeutic implications, but clearly all share the aim to promote a meaningful transformation in order to generate convincing narratives that “persuasively influence clients to accept more adaptive explanations for their disorders and take ameliorative actions” ( Wampold, 2007 ).

However, the exemplified approaches differ with regard to the extent this is communicated in both the treatment rationale and to the clients. Therefore, different kinds of psychotherapy can be distinguished by the way in which they explicitly engage and lead to transform clients’ meaning in more adaptive ways. Considering the importance of the transformation of meaning through narratives in psychotherapy and the varying degree this is openly defined as a characteristic constituent of the given approach and communicated to clients, we believe that psychotherapy would benefit from acknowledging this within education and training, and (arguably) in communicating this to clients.

The described therapeutic schools are all placed in an interpersonal context marked by empathy, warmth, cooperation, and transparency ( Langhoff et al., 2008 ). However, different emphases of the therapist’s and client’s roles are apparent. In cognitive therapies, the therapists assist their clients in constructing narratives that fit their perception of the world and their particular present challenges ( Meichenbaum, 1993 ). In systemic therapy, therapists aim to understand and accept how each member of a system understands reality and which unique narratives describe the current problem ( Selvini et al., 1980 ), while person-centered therapists promote a shared and empathetic understanding of clients’ narratives ( Rogers, 1957 ).

The current conceptual analysis has the limitation to focus only on a selective choice of therapeutic approaches, with no claim to be complete regarding therapeutic theories, rationales, techniques, and strategies ( Blease, 2015 ). However, the chosen psychotherapy approaches are illustrative as they differ significantly in focus, underlying treatment theory and paradigmatic orientation.

To conclude, the meaning and their underlying narratives matter—regardless of the specific psychotherapy approach. However, this importance is not equally well acknowledged by the examined approaches or to rephrase this observation in the terms of Grünbaum’s ( Grünbaum, 1981 ; Howick, 2017 ) definition of intervention constituents and with regard to Rosenzweig’s (1936) early and seminar observation: The characteristic factors that actually are operating in several different therapies—the transformation of meaning—may not have much more in common than have the factors alleged to be operating. The ethical obligation at hand is to make these characteristic elements of psychotherapy, which promote the change from non-adaptive into adaptive explanations, allowing the client to feel better, function more favorably, and think more adaptively, transparent in both, therapeutic manuals and the informed consent of clients ( Blease et al., 2016 ; Gaab et al., 2016 ; Trachsel and Gaab, 2016 ).

Author Contributions

CL, SM, and JG conceived and designed the conceptual analysis. CL drafted the paper. CL, SM, and JG wrote the final paper, critically revised the manuscript and gave important intellectual contribution to it.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors wish to thank Deborah Meier, Cora Wagner, Sarah Bürgler, and Linda Kost for their assistance with editing the manuscript. Further, we would like to thank Süheyla Seker for her conceptual contribution.

Funding. CL, PhD, received funding from the Swiss National Science Foundation (SNSF): P400PS_180730.

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What to Know About Logotherapy

This type of therapy helps you find your purpose in life

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Ascent / PKS Media Inc. / Getty Images

Effectiveness

Things to consider, how to get started.

Logotherapy is a therapeutic approach that helps people find personal meaning in life. It’s a form of psychotherapy that is focused on the future and on our ability to endure hardship and suffering through a search for purpose.

Psychiatrist and psychotherapist Viktor Frankl developed logotherapy prior to his deportation to a concentration camp at age 37. His experience and theories are detailed in his book, "Man’s Search for Meaning."

Frankl believed that humans are motivated by something called a "will to meaning," which is the desire to find meaning in life. He argued that life can have meaning even in the most miserable of circumstances and that the motivation for living comes from finding that meaning.

Viktor Frankl, MD, PhD

Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.

This opinion was based on his experiences in the concentration camps and his intent to find meaning through his suffering. In this way, Frankl believed that when we can no longer change a situation, we are forced to change ourselves.

Click Play to Learn More About Viktor Frankl’s Logotherapy

This video has been medically reviewed by Daniel B. Block, MD .

Frankl believed that it was possible to turn suffering into achievement and accomplishment. He viewed guilt as an opportunity to change oneself for the better and life transitions as the chance to take responsible action.

In this way, logotherapy is aimed at helping you to make better use of your "spiritual" resources to withstand adversity. Three techniques intended to help with this process include dereflection, paradoxical intention, and Socratic dialogue.

Dereflection

Dereflection is aimed at helping you focus away from yourself and toward other people allowing you to become "whole" and to spend less time feeling preoccupied with a problem or worry. 

This technique is meant to combat "hyper-reflection," or extreme focus on an anxiety-provoking situation or object. Hyper-reflection is often common in people with anticipatory anxiety .

Paradoxical Intention

Paradoxical intention is a technique that invites you to wish for the thing that you fear most. This was originally suggested for use in the case of anxiety or phobias , in which humor and ridicule can be used when fear is paralyzing. 

For example, if you have a fear of looking foolish, you might be encouraged to try to look foolish on purpose. Paradoxically, your fear would be removed when you set an intention to behave as foolishly as possible.

Socratic Dialogue

Socratic dialogue is a tool used to help you through the process of self-discovery by noticing and interpreting your own words. During Socratic dialogue, your therapist listens closely to the way you describe things and points out your word patterns, helping you to see the meaning in them. This process is believed to help you realize your own answers—often, these are already present within you and are just waiting to be discovered.

It’s easy to see how some of the techniques of logotherapy overlap with newer forms of treatment such as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) . In this way, logotherapy may be a complementary approach for these behavior and thought-based treatments.

What Logotherapy Can Help With

Perhaps not surprisingly, there is evidence that meaning in life correlates with better mental health. This knowledge might be applied in areas such as:

• Anxiety  
• Depression  
• Grief  
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Substance abuse 
• Suicidal ideation

Frankl believed that many illnesses or mental health issues are disguised existential angst and that people struggle with lack of meaning, which he referred to as the "existential vacuum." Logotherapy addresses that lack of meaning directly by helping people uncover that meaning and reduce their feelings of angst.

Benefits of Logotherapy

Logotherapy may improve resilience —or the ability to withstand adversity, stress, and hardship. This may be due to the skills that this form of therapy encourages people to develop, like:

• Allowance of "healthy" stress
• An active approach to life (rather than an avoidant or overly passive one)
• Cognitive reappraisal, or reinterpreting the meaning of an event
• Courage to face fears
• Optimism even in the face of tragedy
• Responsibility
• Spirituality (which may or may not be religious)
• Values-based lifestyle

Having a meaning or purpose in life (or engaging in a search for meaning) appears to be connected to your overall health, happiness, and life satisfaction. It also acts as a positive influence on your resilience. Research supports this connection and shows that some people with mental or physical health conditions may struggle to feel like their lives have meaning.

Logotherapy appears to improve people’s sense of meaning and is effective at:

• Improving the quality of life for early adolescents with cancer
• Reducing depression in children
• Reducing job burnout and empty nest syndrome
• Increasing marital satisfaction

While logotherapy isn’t inherently religious, it is focused on spiritual and philosophical concepts, and it is concerned with helping people who feel lost or dissatisfied on a spiritual level. While many find comfort in this approach, it may pose problems if you’re not a spiritual or philosophical person.

Similarly, logotherapy is focused on helping people uncover purpose or meaning. If you already feel that you understand the meaning of your life or your problems aren’t existential in nature, this form of treatment may not be a good fit for you. 

Logotherapy is also not intended to be the sole treatment for some conditions. While logotherapy may offer benefits for someone living with schizophrenia, for example, treatment for their condition may also include medication and additional forms of psychotherapy.

Logotherapy may be offered as a primary therapeutic approach, or its principles might be combined with another form of therapy or treatment option. Logotherapy can be offered in person or online, and can be administered individually or as group therapy . Your doctor may be able to recommend local treatment options.

During your sessions, your therapist will educate you on core principles of logotherapy, like:

• You are made up of a body, mind, and spirit, and your spirit is your essence.
• Your life has meaning no matter your circumstances. 
• All people have a motivation to find meaning in their lives, and uncovering that meaning allows us to endure pain and suffering.
• You always have the freedom to find your own meaning, and you can choose your attitude even in situations that you can’t change.
• For decisions to be meaningful, you must live in ways that match the values of society or your own conscience.
• All individuals are unique and irreplaceable.

You’ll be expected to act as an active participant in the therapy process (rather than a passive recipient), and you’ll be encouraged to take responsibility in your own search for meaning and purpose in life.

If you’re interested in logotherapy but aren’t sure you want to pursue formal treatment, you can also learn to apply some of the core concepts to your everyday life. Try:

• Creating something : Creating something such as art gives you a sense of purpose, which can add meaning to your life.
• Developing relationships : Social support can help you to develop more of a sense of meaning.
• Finding purpose in pain : If you are going through something negative, try to find a purpose in it. Even if this is a bit of mental trickery, it will help to see you through.
• Understanding that life is not fair : There is nobody keeping score, and you will not necessarily be dealt a fair hand. However, life can always have meaning, even in the worst of situations.
• Embracing your freedom to find meaning : Remember that you are always free to make meaning out of your situation; nobody can take that away from you.
• Focusing on others : Try to focus outside of yourself. This may help you to stop feeling mentally "stuck" on a situation in your own life.
• Accepting the worst : When you’re prepared to accept the worst, it reduces the power that it has over you.

Frankl VE. Man’s Search for Meaning . Boston, 2006.

Thir M, Batthyány A. The state of empirical research on logotherapy and existential analysis . In: Batthyány A, ed. Logotherapy and Existential Analysis . New York City; 2016:53-74. doi:10.1007/978-3-319-29424-7_7

Southwick SM, Lowthert BT, Graber AV. Relevance and application of logotherapy to enhance resilience to stress and trauma . In: Batthyány A, ed. Logotherapy and Existential Analysis . New York City; 2016:131-149. doi:10.1007/978-3-319-29424-7_13

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

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Guest Essay

The Heat Wave Scenario That Keeps Climate Scientists Up at Night

By Jeff Goodell

Mr. Goodell is the author of “The Heat Will Kill You First: Life and Death on a Scorched Planet.”

On a recent Thursday evening, a freakish windstorm called a derecho (Spanish for “straight ahead”) hit Houston, a city of more than two million people that also happens to be the epicenter of the fossil fuel industry in America.

In a matter of minutes, winds of up to 100 miles per hour blew out windows on office buildings, uprooted trees and toppled electric poles and transmission towers. Nearly a million households lost power. Which meant that not only was there no light, but there was no air-conditioning. The damage from the storm was so extensive that, five days later, more than 100,000 homes and businesses were still marooned in the heat and darkness.

Luckily, the day the derecho blew in, the temperature in Houston, a city infamous for its swampy summers, was in the low to mid-80s. Hot, to be sure, but for most healthy people, not life-threatening. Of the at least eight deaths reported as a result of the storm, none were from heat exposure.

But if this storm had arrived several days later, perhaps over the Memorial Day weekend, when the temperature in Houston hit 96 degrees, with a heat index as high as 115, it might have been a very different story. “The Hurricane Katrina of extreme heat,” is how Mikhail Chester, director of the Metis Center for Infrastructure and Sustainable Engineering at Arizona State University, once put it to me, echoing the memory of the catastrophic 2005 hurricane that struck Louisiana, devastated New Orleans and killed more than 1,300 people.

Most people who died in Louisiana during Katrina died from drownings, injuries or heart conditions. But Dr. Chester was using Katrina as a metaphor for what can happen to a city unprepared for an extreme climate catastrophe. In New Orleans, the levee system was overwhelmed by torrential rains ; eventually, 80 percent of the city was underwater.

What if, instead, the electricity goes out for several days during a blistering summer heat wave in a city that depends on air-conditioning in those months?

In Dr. Chester’s scenario, a compounding crisis of extreme heat and a power failure in a major city like Houston could lead to a series of cascading failures, exposing vulnerabilities in the region’s infrastructure that are difficult to foresee and could result in thousands, or even tens of thousands, of deaths from heat exposure in a matter of days. The risk to people in cities would be higher because all the concrete and asphalt amplifies the heat, pushing temperatures as much as 15 degrees to 20 degrees in the midafternoon above surrounding vegetated areas.

The derecho that hit Houston was a warning of just how quickly risks are multiplying in our rapidly warming world. As if to prove this point, some 10 days after the Houston blackout, another windstorm knocked out power to hundreds of thousands of homes and businesses in and around Dallas.

One of the most dangerous illusions of the climate crisis is that the technology of modern life makes us invincible. Humans are smart. We have tools. Yeah, it will cost money. But we can adapt to whatever comes our way. As for the coral reefs that bleach in the hot oceans and the howler monkeys that fell dead out of trees during a recent heat wave in Mexico, well, that’s sad but life goes on.

This is, of course, an extremely privileged point of view. For one thing, more than 750 million people on the planet don’t have access to electricity, much less air-conditioning. (In India, New Delhi experienced temperatures as high as 120 degrees last week, leading to an increase in heatstroke, fears of blackouts and the possibility of water rationing.) But it is also a naïve point of view, if only because our bubble of invincibility is far more fragile than we know. So what can we expect in a heat Katrina?

Last year, researchers at Georgia Institute of Technology, Arizona State University and the University of Michigan published a study looking at the consequences of a major blackout during an extreme heat wave in three cities: Phoenix, Detroit and Atlanta. In the study, the cause of the blackout was unspecified.

“It doesn’t really matter if the blackout is the result of a cyberattack or a hurricane,” Brian Stone, the director of the Urban Climate Lab at Georgia Tech and the lead author on the study, told me. “For the purposes of our research, the effect is the same.” Whatever the cause, the study noted that the number of major blackouts in the United States more than doubled between 2015-16 and 2020-21.

Dr. Stone and his colleagues focused on those three American cities because they have different demographics, climates and dependence on air-conditioning. In Detroit, 53 percent of buildings have central air-conditioning; in Atlanta, 94 percent; in Phoenix, 99 percent. The researchers modeled the health consequences for residents in a two-day, citywide blackout during a heat wave, with electricity gradually restored over the next three days.

The results were shocking: in Phoenix, about 800,000 people — roughly half the population — would need emergency medical treatment for heat stroke and other illnesses. The flood of people seeking care would overwhelm the city’s hospitals. More than 13,000 people would die.

Under the same scenario in Atlanta, researchers found there would be 12,540 visits to emergency rooms. Six people would die. In Detroit , which has a higher percentage of older residents and a higher poverty rate than those other cities, 221 people would die.

Perhaps we should not be surprised by these numbers. Researchers estimate 61,672 people died in Europe from heat-related deaths in the summer of 2022, the hottest season on record on the continent at the time. In June of 2021, a heat wave resulted in nearly 900 excess deaths in the Pacific Northwest. And in 2010, an estimated 56,000 Russians died during a record summer heat wave.

The hotter it gets, the more difficult it is for our bodies to cope, raising the risk of heat stroke and other heat illnesses. And it is getting hotter across the planet. Last year was the warmest year on record, and the 10 hottest years have all occurred in the last decade.

In the study simulating a heat wave in those three cities, researchers found that the much larger death toll in Phoenix was explained by two factors. First, the temperatures modeled during a heat wave in Phoenix (90 to 113 degrees) were much higher than the temperatures in Atlanta (77 to 97 degrees) or Detroit (72 to 95 degrees). And second, the greater availability of air-conditioning in Phoenix means the risks from a power failure during a heat wave are much higher.

A lot can be done to reduce these risks. Building cities with less concrete and asphalt and more parks and trees and access to rivers and lakes would help. So would a more sophisticated nationally standardized heat wave warning system. Major cities also need to identify the most vulnerable residents and develop targeted emergency response plans and long-term heat management plans.

Making the grid itself more resilient is equally important. Better digital firewalls at grid operation centers thwart hacker intrusions. Burying transmission lines protects them from storms. Batteries to store electricity for emergencies are increasingly inexpensive.

But the hotter it gets, the more vulnerable the grid becomes, even as demand for electricity spikes because customers are running their air-conditioning full throttle. Transmission lines sag, transformers explode, power plants fail. One 2016 study found the potential for cascading grid failures across Arizona to increase 30-fold in response to a 1.8 degree rise in summer temperatures.

“Most of the problems with the grid on hot days come from breakdowns at power plants or on the grid caused by the heat itself, or from the difficulty of meeting high demand for cooling,” Doug Lewin, a grid expert and author of the Texas Energy and Power newsletter , told me. The best way to fix that, Mr. Lewin argued, is to encourage people to reduce power demand in their homes with high efficiency heat pumps, better insulation and smart thermostats, and to generate their own power with solar panels and battery storage.

The looming threat of a heat Katrina is a reminder of how technological progress creates new risks even as it solves old ones. On a brutally hot day during a recent trip to Jaipur, India, I visited an 18th century building that had an indoor fountain, thick walls, and a ventilation system designed to channel the wind through each room. There was no air-conditioning, but the building was as cool and comfortable as a new office tower in Houston.

Air-conditioning may indeed be a modern necessity that many of us who live in hot parts of the world can’t survive without. But it is also a technology of forgetting. Once upon a time, people understood the dangers of extreme heat and designed ways to live with it. And now, as temperatures rise as a result of our hellbent consumption of fossil fuels, tens of thousands of lives may depend on remembering how that was done. Or finding better ways to do it.

Jeff Goodell is the author of “The Heat Will Kill You First: Life and Death on a Scorched Planet.”

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Logotherapy: Viktor Frankl’s Theory of Meaning

When we bask in the glory of a sunset and reflect on creation or enjoy the embrace of a loved one, it provides meaning.

As we engage with our community, participate in creative endeavors, and support a cause greater than ourselves, we experience the value of life.

What is it then that brings meaning to life? What is it that makes those hard moments, the dark nights, and endless struggles worth the fight?

The quest to answer “what is the meaning of life?” has been around since the beginning of time. To find meaning in life can be seen as the primary motivation of each person, and the concept of logotherapy is based on that proposition.

In the following article, we will take a deep dive into the creation of logotherapy, research, techniques, and worksheets.

Before you read on, we thought you might like to download our three Meaning & Valued Living Exercises for free . These creative, science-based exercises will help you learn more about your values, motivations, and goals and will give you the tools to inspire a sense of meaning in the lives of your clients, students, or employees.

This Article Contains:

Logotherapy: a definition, who was viktor frankl, viktor frankl’s theory, research and empirical results, 3 techniques of logotherapy, 4 activities and worksheets, 6 famous quotes on life and meaning, 5 books on the topic, our meaning & valued living masterclass, a take-home message.

Logotherapy is often referred to as the “ third Viennese school of psychotherapy ,” and it originated in the 1930s as a response to both Freud’s psychoanalysis and Adler’s emphasis on power within society. It is more than just “therapy.” It is a philosophy for the spiritually lost and an education for those who are confused. It offers support in the face of suffering and healing for the sick (Guttmann, 2008).

Logotherapy examines the physical, psychological, and spiritual (noological) aspects of a human being, and it can be seen through the expression of an individual’s functioning. It is often regarded as a humanistic–existential school of thought but can also be used in conjunction with contemporary therapies (McMullin, 2000).

In contrast to Freud’s “ will to pleasure ” and Adler’s “ will to power ,” logotherapy is based on the idea that we are driven by a “ will to meaning ” or an inner desire to find purpose and meaning in life (Amelis & Dattilio, 2013).

As humans, we often respond to situations in the first two dimensions of functioning (physical/psychological) with conditioned and automatic reactions. Examples of these reactions include negative self-talk, irrational actions, outbursts, and negative emotions.

Animals also respond in the first two dimensions. It is the third dimension of functioning that separates humans from other species. This is the unique beauty of logotherapy.

While humans can survive just like animals living within the first two dimensions (satisfying physical needs and thinking), logotherapy offers a deeper connection to the soul and an opportunity to explore that which makes us uniquely human.

The spiritual dimension is one of meaning. The basic tenets of logotherapy are that

• human life has meaning,
• human beings long to experience their own sense of life meaning, and
• humans have the potential to experience meaning under any and every circumstance (Schulenberg, 2003).

The Austrian psychiatrist and neurologist was born March 26, 1905, and is best known for his psychological memoir Man’s Search for Meaning (2006) and as the father of logotherapy.

He published 40 books that have been translated into 50 languages, demonstrating that love, freedom, meaning, and responsibility transcend race, culture, religion, and continents.

His most famous memoir begins by outlining a personal experience through the gruesome Auschwitz concentration camps. The three years he spent in concentration camps became more than a story of survival. Frankl embodies the modern-day definition of resilience.

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Frankl viewed logotherapy as a way to enhance existing therapies by emphasizing the “meaning-dimension” or spiritual dimension of human beings. Three philosophical and psychological concepts make up Frankl’s logotherapy: freedom of will, will to meaning, and meaning of life (Batthyany, 2019).

Freedom of will asserts that humans are free to decide and can take a stance toward both internal and external conditions. Freedom in this context is defined as a space to shape one’s own life within limits of specific possibilities. It provides the client with room for autonomy in the face of somatic or psychological illness. In essence, we are free to choose our responses no matter our circumstances.

Will to meaning states that humans are free to achieve goals and purposes in life. Frustration, aggression, addiction, depression, and suicidality arise when individuals cannot realize their “will to meaning.” As humans, our primary motive is to search for meaning or purpose in our lives. We are capable of surpassing pleasure and supporting pain for a meaningful cause.

Meaning in life is based on the idea that meaning is an objective reality rather than merely an illusion or personal perception. Humans have both freedom and responsibility to bring forth their best possible selves by realizing the meaning of the moment in every situation.

Can we find meaning under all circumstances, even unavoidable suffering? We can discover meaning in life through creative clues, experiential values, and attitudinal values (Lewis, 2011).

Viktor Frankl: Logotherapy and man’s search for meaning

Logotherapy has significant application to every dimension of an individual (the tri-dimensional ontology). Psychologically, logotherapy uses the specific techniques of paradoxical intention and dereflection to deal with problems of anxiety, compulsive disorders, obsessions, and phobias. These will be discussed in further detail in the next section.

Physiologically, logotherapy is an effective way to cope with suffering and physical pain or loss. Spiritually, logotherapy demonstrates that life has meaning or purpose when people suffer from the “existential vacuum” that we experience as boredom, apathy, emptiness, and depression (Frankl, 2006).

1. PTSD and acute stress

One of the most effective things about logotherapy is its ability to empower individuals, allowing them to be freed from their symptoms and increase their capacity to be proactive.

Since logotherapy was founded on a preface of suffering, it is a natural therapy for treating traumatic experiences. Logotherapy is a useful treatment for individuals with acute stress disorder or post-traumatic stress disorder (PTSD).

In numerous case studies of clients with combat-related PTSD, logotherapy exercises that highlight the construct of meaning led to a significant decrease in symptoms of stress, anxiety, and depression (Schiraldi, 2000). Research on logotherapy’s effectiveness for treating PTSD has mostly been established through qualitative research and case studies.

2. Alcohol and drug treatment

There are obvious parallels between the spiritual elements of Alcoholics Anonymous and the concepts of discovering personal meaning found in logotherapy.

Frankl (2006) discussed a “mass neurotic triad” of aggression, depression, and addiction that occurs when individuals experience an existential vacuum. This vacuum leads to violations of social norms, symptoms of stress, and addiction.

The treatment for this existential vacuum is, of course, to guide the client into discovering the freedom to choose, the will to find meaning, and the responsibility of living a purposeful life (Hutzell, 1990).

Logotherapy has been effective in reducing cravings and participation in drinking among alcoholics. Additionally, logotherapy groups successfully improved the meaning of life and mental health among wives of alcoholics (Cho, 2008).

Frankl would argue that when individuals can tap into their freedom, responsibility, and life purpose, there is no longer a need or desire for mind-altering substances like alcohol or drugs.

3. Anxiety and depression

Logotherapy has successfully been used to treat depression and anxiety. One study looked specifically at depression and stress among cervical cancer patients (Soetrisno & Moewardi, 2017).

Researchers measured cortisol levels (stress hormone) and scores from the Beck Depression Inventory (BDI) among two groups of 15 patients. One group received logotherapy treatment for a total of six weeks (45-minute sessions once per week), and the control group received standard cancer treatment.

After six weeks, there was a significant decrease in BDI scores and levels of cortisol for the treatment group, while the control group had no change (Soetrisno & Moewardi, 2017). It makes sense that improving the meaning of life for cancer patients decreased their levels of stress and depression.

Logotherapy also successfully decreased measurable levels of suffering and increased the meaning of life in a group of adolescent cancer patients when compared with a matched control group (Kang et al., 2009).

Similarly, two-hour sessions of logotherapy among a group of 22 breast cancer patients significantly decreased BDI scores (Hagighi, Khodaei, and Sharifzadeh, 2012). This research demonstrated that logotherapy can be a beneficial treatment for individuals struggling through cancer or other major illnesses.

4. Group logotherapy

There is also significant research to support the use of logotherapy in group settings. Instructing both individuals and groups on the dimensions of responsibility, freedom, and values can help decrease suffering and increase various measures of psychological wellbeing.

When comparing the effectiveness of gestalt and logotherapy in a group setting of divorced women, logotherapy provided a more substantial decrease in depression, anxiety, and aggression (Yousefi, 2006).

Group logotherapy also led to increased psychological wellbeing, positive relationships, autonomy, personal growth, and mastery among mothers of children with intellectual disabilities (Faramarzi & Bavali, 2017).

There are similarities between the therapeutic techniques of logotherapy and both Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT).

1. Dereflection

The first technique is dereflection, which is aimed at helping clients focus attention away from problems and complaints and toward something positive. It is based on the concept of self-distancing and self-transcendence .

Practically speaking, it involves asking questions like “ What would your life be like without X problem? ”; “ If everything went perfectly in your life, what would that look like? ”; and “ Is there anything in your life you would die for? ”

2. Paradoxical intention

Paradoxical intention is an effective technique to use with phobias, fear, and anxiety.

The basis of this technique is that humor and ridicule can be useful when fear is paralyzing. Fear is removed when action/intention focuses on what is feared the most. For example, if a person struggles with a fear of rejection, they would purposely put themselves in positions where they would be rejected or told “no.”

An apt illustration is in Harry Potter and the Prisoner of Azkaban (Rowling, 1999), where young students had to face their worst fears. To conquer their fear, they had to turn the terrifying thought into something laughable, such as a big spider on roller skates, thereby ridiculing and overcoming the paralyzing fear.

3. Socratic dialogue

Socratic dialogue is a tool in logotherapy that walks a client through a process of self-discovery in their own words.

It is different from Socratic questioning , which is often used in CBT. Socratic questioning breaks down anxious or negative thoughts, while Socratic dialogue is used to find meaning within a conversation. It allows the client to realize they already have the answers to their purpose, meaning, and freedom.

Our Positive Psychology Toolkit© contains over 400 tools, exercises and questionnaires to assist therapists, coaches and educators, to name a few. Some of these worksheets are described below.

1. Valued Living During Challenging Times

A perfect fit for Frankl’s logotherapy, the Valued Living During Challenging Times worksheet has clients reflect on a challenging circumstance and reconnect with personal values. Through this process, clients can find meaning in their suffering and become more resilient and tolerant of stress.

2. Passengers on the Bus group activity

The empirically tested metaphor “passengers on the bus” has been effectively used in ACT interventions. The Passengers on the Bus group activity uses role-play and debriefing to help clients learn to react to distressing situations in line with their values rather than choosing to avoid painful situations or act on their emotions.

3. A Value Tattoo

While logotherapy uses Socratic dialogue to find meaning, the Value Tattoo worksheet is helpful for clients who might find questions difficult or confronting. Instead of asking, “ What is most important in life? ” the client is encouraged to use creativity and imagine a tattoo that would be meaningful to them.

4. Find Your Purpose worksheet

This Find Your Purpose worksheet asks a series of basic questions designed to identify gifts, talents, skills, and abilities, which can ultimately reflect finding purpose in life. By finding your purpose and using your strengths in a positive way, you can create a lasting impact on the world around you and ultimately find meaning in life.

While finding the meaning of life seems to be at the forefront of logotherapy, Frankl argued that instead of asking this question, an individual should realize that they are the one being questioned.

He stated, “ It doesn’t really matter what we expected from life, but what life expected from us ” (Frankl, 1986).

Other notable quotes from Frankl’s Man’s Search for Meaning (2006) include:

When we are no longer able to change a situation, we are challenged to change ourselves.

Suffering is an ineradicable part of life, even as fate and death. Without suffering and death human life cannot be complete. For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side-effect of one’s personal dedication to a cause greater than oneself or as the by-product of one’s surrender to a person other than oneself.

Related famous quotes include:

He who has a why to live for can bear with almost any how.

• Man’s Search for Meaning (2006) is the best place to start for a brief background on Viktor Frankl and a great introduction to logotherapy. ( Amazon )
• The Will to Meaning (Frankl, 2014) dives a bit deeper into the application of logotherapy ( Amazon )
• Frankl’s The Doctor and the Soul: From Psychotherapy to Logotherapy (1986) is the first book published after his release from Nazi concentration camps. He discusses that the fundamental human drive is not sex (Freud’s view) or the need for approval (Adler’s perspective) but the drive to have a meaningful life . ( Amazon )
• In the book Viktor Frankl’s Logotherapy , author Ann Graber (2019) focuses on the practical application of logotherapy and the effectiveness of using the spiritual dimension in existential therapy to find healing. ( Amazon )
• Joseph Fabry compiles work on logotherapy in the text Finding Meaning in Life: Logotherapy (1995) , which can specifically help clients with drug, alcohol, or life adjustment issues. ( Amazon )

For more reading, visit our post listing the 7 Best Books to Help You Find the Meaning of Life .

World’s Largest Positive Psychology Resource

The Positive Psychology Toolkit© is a groundbreaking practitioner resource containing over 500 science-based exercises , activities, interventions, questionnaires, and assessments created by experts using the latest positive psychology research.

Updated monthly. 100% Science-based.

“The best positive psychology resource out there!” — Emiliya Zhivotovskaya , Flourishing Center CEO

The apparent parallels between positive psychology and Viktor Frankl’s logotherapy are endless.

While there are also notable differences, there is no denying that finding value and meaning in this journey of life leads to an array of positive outcomes.

The Meaning & Valued Living Masterclass provides an excellent background of positive psychology. It builds on the sailboat metaphor by emphasizing the types and paradox of meaning. By introducing practical exercises to find meaning and values, professionals can immediately apply techniques to address a wide range of issues.

One of the best things about positive psychology and the practicality of this masterclass is that it can improve life and wellbeing for those who are struggling, those who are suffering, and those who are looking to thrive.

If you’re looking for more science-based ways to help others discover meaning, this collection contains 17 validated meaning tools for practitioners. Use them to help others choose directions for their lives in alignment with what is truly important to them.

Perhaps the question, “ what is the meaning of life? ” is not the right question for us.

Asking this question is like addressing the symptom rather than the actual problem.

If we worked on finding sources of meaning within our lives through both the good and bad experiences, then we could gain relief from existential issues and increase our resilience and wellbeing.

Once we find these potential sources of meaning and align them with our personal values and strengths, that will ultimately result in the most profound sense of joy and meaning possible.

We hope you enjoyed reading this article. Don’t forget to download our three Meaning & Valued Living Exercises for free .

• Amelis, M., & Dattilio, F. M. (2013). Enhancing cognitive behavior therapy with logotherapy: Techniques for clinical practice. Psychotherapy , 50 (3), 387–391.
• Batthyany, A. (2019). What is logotherapy/existential analysis? Logotherapy and existential analysis. Viktor Frankl Institut . Retrieved from https://www.viktorfrankl.org/logotherapy.html
• Cho, S. (2008). Effects of logo-autobiography program on meaning in life and mental health in the wives of alcoholics. Journal of Asian Nursing Research , 2 (2), 129–139.
• Fabry, J. B. (1995).  Finding meaning in life: Logotherapy . Jason Aronson.
• Faramarzi, S., & Bavali, F. (2017). The effectiveness of group logotherapy to improve psychological wellbeing of mothers with intellectually disabled children. International Journal of Developmental Disabilities , 63 (1), 45–51.
• Frankl, V. E. (1986). The doctor and the soul. Penguin Random House.
• Frankl, V. E. (2006). Man’s search for meaning. Beacon Press.
• Frankl, V. E. (2014).  The will to meaning: Foundations and applications of logotherapy  (Expanded ed.). Plume.
• Graber, A. V. (2019).  Viktor Frankl’s logotherapy: Method of choice in ecumenical pastoral psychology  (2nd ed.).   Wyndham Hall Press.
• Guttmann, D. (2008). Finding meaning in life, at midlife and beyond: Wisdom and spirit from logotherapy. Praege Inc.
• Hagighi, F., Khodaei, S., & Sharifzadeh, G. R. (2012). Effect of logotherapy group counseling on depression in breast cancer patients. Modern Care Journal , 9 (3), 165–172.
• Hutzell, R. R. (1990). An introduction to logotherapy. In P. A. Keller & S. R. Heyman (Eds.) Innovations in clinical practice: A source book. Professional Resource Exchange.
• Kang, K. A., Im, J. I., Kim, H. S., Kim, S. J., Song, M. K., & Songyong, S. (2009). The effect of logotherapy on the suffering, finding meaning, and spiritual wellbeing of adolescents with terminal cancer. Journal of Korean Academy of Child Health Nursing , 15 (2), 136–144.
• Lewis, M. H. (2011). Defiant power: An overview of Viktor Frankl’s logotherapy and existential analysis. Retrieved June 19, 2020, from www.defiantpower.com.
• McMullin, R. E. (2000). The new handbook of cognitive therapy techniques. Norton Press.
• Rowling, J. K. (1999).  Harry Potter and the Prisoner of Azkaban. Bloomsbury Publishing.
• Schulenberg, S. E. (2003). Empirical research and logotherapy. Psychological Reports , 93 , 307–319.
• Schiraldi, G. R. (2000). Post traumatic stress disorder sourcebook: A guide to healing, recovery and growth. Lowell House.
• Soetrisno, S., & Moewardi. (2017). The effect of logotherapy on the expressions of cortisol, HSP70, Beck Depression Inventory (BDI), and pain scales in advanced cervical cancer patients. Health Care for Women International , 38( 2), 91–99.
• Yousefi, N. (2006). Comparing the effectiveness of two counseling approaches of gestalt therapy and logotherapy on decrease of depression symptoms, anxiety and aggression among women divorce applicants. Cross-Country Congress of Family Pathology , 10 (3), 658–663.

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What our readers think.

I am a trauma survivor, I didn’t even realize, what I was dealing with for such a long time was PTSD, Disassociation, Depression, Grief and Anxiety. I found a lot of relief when I discovered that I have the power, in how I perceive my past. I listen more than I speak, unless someone wants to hear what I have to say. During COVID-19 I was deemed an essential worker, I am an Auto Technician, before and during COVID-19 I was Shop Manager, I had never felt such extreme pressure knowing that the safety of the people I work with was in my hands. I drove to work everyday with no other car in sight, until I got to work. The atmosphere was so tense, I felt where I cut into it, as I walked from my car to the building I work in, I could not understand other managers attitudes and why I questioned mine. Like a wise Philosopher once said in a moment of chaos, normal behavior seems abnormal. I encouraged everyone everyday, letting them know, this wasn’t the first time in history this has happened, just like the Philosopher King Marcus Aurelius. Everyday I had something humors to say. I am used to pressure, being I grew up around violence and witnessed a kid get shot and killed by drive a by. This wasn’t my first Rodeo. What was going on in the moment, did not phase me. I would find justification in my own way, why things happen. I continued until my back eventually gave out from so much stress. I felt guilt that I had never felt before, I kept giving happiness and hope until I lost my own, and gave into the excruciating pain that bulging disc in my lower back produce. This was the life changing moment in my life. COVID-19 in full bloom and running rampant, I did not turn to traditional medicine. Instead I found a Phycologist and Therapist that helped me get past my own internal struggles, as I have come together with myself and countless hours of reading, exercising, meditation, yoga, and Philosophy. I have come to this website. After reading your article, and understanding my own struggles, I am a firm believer Logotherapy can help so many people.

Dr. Melissa Madeson, Thank you for your well defined points about V Frankle and logotherapy. I once led a group of seniors at a convalescent center. We discussed the meaningful moments they recalled in their lives. I encouraged the participants to write their short and focused memoirs. These writings were subsequently published in a small volume. The writers and participants took part in a public reading, with family, friends, facility staff , and public in attendance. Overall, the lectures, writing, and readings were meaningful to all involved.

Finding meaning in trauma patients’ stories help them heal. Their traumas don’t define them, they’re just facts when their stories make sense. I am a trauma therapist and I love Viktor Frankl. This article actually helped me realize that how I work with trauma patients is actually how logotherapy help patients. Thank you.

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Existential therapy is a type of psychotherapy ( talk therapy ) that encourages people to use their free will to create meaning and purpose in life if they feel lost, hopeless, or alienated. It can help someone with depression, anxiety disorders, or substance addiction understand how their personal choices influence their future.

Existential therapy is based on existentialism, a philosophy in which life is considered "meaningless" and meaning can only be found through one's own choices. It reinforces the belief that each person has a personal responsibility for their behaviors.

This article explains how existential therapy works, who it can help, and the limitations of the practice. It also offers insights into other forms of talk therapy you may pursue.

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What Is Existential Therapy?

Existential therapy is based on existentialism, a philosophical theory that characterizes individuals as free and responsible agents who influence the course of their lives through acts of will.

As a philosophy, existentialism is grounded on the acceptance of four "givens," namely:

• Freedom : People have the freedom and responsibility to create meaningful lives.
• Isolation: People are ultimately alone.
• Meaninglessness : Life can feel meaningless.
• Death: No one can escape death.

In psychotherapy, existential therapy is founded on the belief that each person has the free will to make choices and find meaning in their life, even if the human condition seems lonely, meaningless, and temporary.

It reframes experiences like loneliness, anxiety, and hopelessness as neither "good" nor "bad" but as states of the human condition. Personal choice, therefore, becomes the one factor that can change these conditions.

By placing the responsibility for change in your own domain, you can identify what you believe to be your life's purpose and set goals to achieve a higher degree of meaning and purpose.

Existentialism vs. Humanism

Existentialism differs slightly from humanism in that humanists characterize people as inherently good. By contrast, existentialists view people as neither inherently bad nor good.

Existential Therapy Techniques

Many existential therapists do not regard the practice as a particular method of psychotherapy. Instead, they treat it as a way of approaching therapy. Rather than labeling someone a "patient," they may regard both parties as "fellow travelers" in search of authentic meaning.

Certain principles that drive the practice of existential therapy:

• Open, interactive dialogue : Focusing on non-judgmental, two-way communication with honesty and trust
• Mindfulness : Being present in the here and now rather than stagnating in the past or obsessing about the future
• Philosophical questioning : Asking questions about the larger meaning of life and sharing your belief on what the meaning of life is
• Treating all experiences as equal : Avoiding dismissiveness or the ranking of experiences by order of importance
• Avoiding labels : Reframing experiences as neither "good" nor "bad" but ones from which you can examine your choices and make new ones
• Creativity and exploration : Looking at many different choices and openly and honestly exploring where each might take you
• Embracing change : Accepting that goals can change as the meaning of life changes
• Contextualizing choices : Examining your choices not only in terms of your own feelings but also relationships, society, and the world at large

While there are no rules as to how long a person needs existential therapy, the practice is goal-oriented. As with other forms of talk therapy, each session typically lasts 45 to 60 minutes and is scheduled once weekly.

Examples of Existential Questions

As one of the facets of existential therapy, philosophical questions allow you to ask yourself:

• Why am I here?
• Is this all there is?
• What can we make of suffering?
• Am I all alone or part of a larger whole?
• What do I value in life?
• What is my true nature?
• Do I have a greater purpose?

Benefits of Existential Therapy

Existential therapy can help anyone who wants to understand how they fit into the world and what makes them feel fulfilled. It can help you figure out how your choices lead to specific outcomes so that you can make better choices.

Existential therapy can be used for people facing many different challenges, including:

• Substance use disorder
• Alcohol use disorder
• Post-traumatic stress disorder (PTSD)
• Chronic pain disorders
• Degenerative conditions like muscular dystrophy
• The loss of a loved one
• Any traumatic or life-changing event

Existential therapy is not only intended for people with extreme issues. It may be just as useful for someone who finds themselves at a crossroads and needs guidance to find new goals and meaning in their life.

Professional Qualifications

Existential therapists hold a minimum of a bachelor’s degree in psychology or a related field, with additional training in philosophy. Others hold a master’s degree in philosophy after obtaining a bachelor’s degree in psychology (or vice versa). Licensure varies by state.

Limitations of Existential Therapy

Existential therapy may not be appropriate for people with conditions like schizophrenia or dementia who need specific primary forms for treatment. The same applies to those whose ability to reason may be impaired, such as someone in an acute manic phase of bipolar disorder or who has major depression with psychotic features .

Anyone with suicidal thoughts should seek immediate care by dialing 988 to speak with a trained responder at the National Suicide and Crisis Lifeline, available 24 hours a day.

Existentialism and God

Existential therapy is founded on a tenet of free will, including the freedom to explore spirituality. In practice, however, the process of decision-making does not involve a "higher power" as it might with programs like Alcoholics Anonymous.

That's not to say that existentialism and a belief in a higher power cannot co-exist; there are, in fact, Christian existential therapists who straddle existentialism and God.

In the end, what is most important is identifying your belief system and being able to speak openly and honestly with any therapist you choose to work with.

Existential therapy may be ideal for people who feel alienated or lost and can see no clear route to changing their lives and giving them meaning.

But if the principles of existentialism do not align with your personal beliefs, or you are searching for self-awareness rather the self-worth, other therapies may be more appropriate, including:

• Cognitive behavioral therapy (CBT) : This involves identifying and changing thought and behavior patterns that are unhealthy and replacing them with effective ones.
• Interpersonal therapy (IPT) : This is a short-term therapy that helps you identify interpersonal issues like unresolved grief and family conflicts that may be interfering with your life and well-being.
• Dialectical behavior therapy (DBT) : This   is a specific type of CBT that helps people with borderline personality disorder, PTSD, and chronic suicidal thoughts regulate their emotions.
• Psychodynamic therapy : This is based on the idea that behavior and mental health are rooted in past traumas and experiences that can be brought from the unconscious to the conscious.

Existential therapy is based on the philosophy of existentialism, which states that people can use their free will to create meaning for themselves. It is a form of talk therapy that incorporates mindfulness and open dialogue to help you understand how the choices you make directly influence changes in your life.

New School of Psychotherapy and Counseling. What is the existential approach?

Crowell S. Existentialism . In: The Stanford Encyclopedia of Philosophy. San Jose, CA: Stanford University Press; 2020.

Heidenreich T, Noyon A, Worrell M, Menzies R. Existential approaches and cognitive behavior therapy: challenges and potential .  Int J Cogn Ther . 2021;14(1):209-234. doi:10.1007/s41811-020-00096-1

Feizi M, Kamali Z, Gholami M, Abadi BAGH, Moeini S. The effectiveness of existential psychotherapy on attitude to life and self-flourishing of educated women homemakers .  J Educ Health Promot . 2019;8:237. doi: 10.4103/jehp.jehp_473_18

American Psychiatric Association. What is psychotherapy?

By Neha Kashyap Kashyap is a New York-based health journalist with a bachelor's degree in print journalism from the University of Southern California.