Helping older adolescents search for meaning in depression.
According to Erikson (1968), the major crisis of adolescence is a search for a consistent identity that includes identification of and adherence to the values and behaviors associated with that identity. Developing this identity is difficult, as youth are often faced with environmental struggles such as poor education, poverty, parental abuse, and conflicting demands from their caregivers and peers. While attempting to cope, adolescents often vent their frustrations by acting out or, conversely, they try to maintain a semblance of personal control by holding their emotions in check. To handle conflicting demands, teenagers often distance themselves from caregivers and conform to the demands of their peer group (Pellebon & Anderson, 1999). Typically, when referred for counseling, adolescents initially display defiance, hostility, or other resistant behavior (Hanna, Hanna, & Keys, 1999). Nonetheless, despite the facade of resistance and being in control, adolescents often feel confused and conflicted about what they should be doing and whom they can trust.
The feeling of being lost among conflicting demands is especially true among youth who have not yet developed a clear sense of their own identities. These youth recurrently conform to the values of their peers, even when these values are in opposition to their own personal beliefs (Pellebon & Anderson, 1999). As a consequence of acting outside of their own value system, even when they are not fully aware of what that value system entails, these youth often feel in conflict with themselves and frequently manifest symptoms of depression or other mental health problems However, as they are given the opportunity to discuss and clarify their values and goals, they gain self-awareness and a clearer sense of identity. As their identity develops, they are better able to resist peer pressure by identifying and adhering to a personal value system, with the result being that their depressive symptoms lessen (Zastrow & Kirst-Ashman, 1997).
Because of the seriousness of adolescent depression, Kutcher (1997) posits that "it is important that effective treatment be delivered quickly and efficiently to those teenagers suffering from a major depressive disorder" (p. 755). The situation is complicated, however, because adolescent depression may have a number of distinct causes such as a chemical imbalance, environmental pressures, interpersonal problems, intrapersonal problems, lack of meaning in one's life, or a combination of these causes (Allen-Meares, 1995). Therefore, in addressing adolescent depression, one would likely hypothesize that no one theory is applicable to all causes of adolescent depression.
In this article I examine the principles of one existential theory, logotherapy, which has the potential of addressing depression among some older adolescents who perceive that their lives are devoid of meaning or are facing difficult challenges and trying to make sense of those challenges. The discussion includes case examples illustrating how some of the major principles of logotherapy can be applied.
According to Krill (1996), there are four recurrent themes in existential theory: (a) individual freedom and the uniqueness of each individual, (b) the recognition of suffering as a necessary part of the human experience, (c) an emphasis on the here and now to discover one's identity and the current meaning of one's life, and (d) a sense of commitment to discover and develop one's talents. It is a "philosophy of practice that centers on the existing person as he or she is emerging and becoming in terms of the self" (Brown & Romanchuk, 1994, p. 50). However, existential theory has only a limited number of techniques for bringing about change; therefore, when employing an existential theory, mental health counselors (MHCs) are free to borrow techniques from other approaches, provided they are consistent with the therapeutic encounter and redirect the client's suffering into constructive channels (Rugala & Waldo, 1998).
One of the complaints against many existential theories is that they include terminology and methods that seem foreign to the average practitioner; conversely, logotherapy is one of the more practical existential theories and includes terminology and methods that are more readily understood (Krill, 1996). Additionally, it is one of the more optimistic and popular models of existential theory: viewing individuals as having the potential to transcend their environments and the freedom and responsibility to make choices that are conducive to growth despite their circumstances. Logotherapy posits the following: (a) the primary and basically subconscious motivation in human existence is a "will to meaning," and (b) depression and other pathology often results when individuals are unable to identify and pursue a worthy meaning (Brown & Romanchuk, 1994; Frankl, 1967; Guttmann, 1996; Lantz, & Alford, 1995). According to Frankl, the author of logotherapy, each person is responsible for the "accomplishment of concrete, personal tasks and demands, the realization of that unique and individual meaning which every one of us has to fulfill" (p. 126).
Logotherapy emphasizes that meaning exists in all circumstances; however, it is hidden and waiting to be discovered. According to Frankl (1967), "We do not just attach and attribute meanings to things, but rather find them; we do not invent them, we detect them" (p. 31). Additionally, this theory underscores the distinct nature of the individual; therefore, individuals need to search carefully for a purpose in various circumstances in order to discover what it means for them.
LOGOTHERAPY: APPLICATION TO ADOLESCENTS
In addressing the modern era and still true in the 21st century, Frankl (1967) notes that the pervasive crisis people face is the feeling, among many, that life is devoid of meaning. He labels this crisis an existential vacuum. Concurring, Guttmann (1996) states that an "existential vacuum characterized by apathy, boredom, and lack of motivation for achievements in life ... is increasingly common in our times, and encompasses large segments of younger and older generations" (p. 14). Feeling existentially empty, individuals search for ways to fill the void and quickly become vulnerable to symptoms such as depression or other problems (Frankl, 1984; Lantz & Alford, 1995).
Adolescents often struggle to gain self-understanding and establish a personal identity because of the conflicting forces surrounding them (Zastrow & Kirst-Ashman, 1997). Many feel a void of meaning in their lives. In addressing this crisis, the role of the MHC is to help "shrink" this existential vacuum by assisting adolescents to "uncover, discover, and make use of the meanings and meaning potentials" in their lives (Lantz & Alford, 1995, p. 16). As youth are able to detect meaning in their circumstance and to pursue that meaning, their focus shifts from their current problems towards the fulfillment of that meaning; as a result, problems are removed from the perceptual spotlight of the individual and often lessen or even disappear (Frankl, 1967; Guttmann, 1996; Lantz & Alford). Further, as they discover meaning in their here and now awareness, this meaning serves as a beacon to guide them and sets the pace for their personal development (Frankl).
However, not all youth are amenable to logotherapy (Corey, 2001). Adolescents most likely to benefit from this theory tend to be introspective and capable of identifying and reflecting on their own beliefs. They have either thought deeply about their own lives, or are willing to critically examine their lives and to contemplate the possibility that they are living below their potential. In addition, older adolescents who are faced with a major crisis such as a life-threatening diagnosis or the death of a loved one may benefit significantly from logotherapy (Corey). Assisting depressed adolescents in discovering and pursuing meaning is facilitated by helping them work through the following steps: (a) establishing the therapeutic relationship; (b) increasing insight regarding identity, values, and goals; (c) refraining depression; (d) discovering meaning within the depression; and (e) pursuing the fulfillment of meaning.
Establishing the Therapeutic Relationship
Connecting with adolescents by gaining their respect and trust is the core of logotherapy and sets the groundwork for everything else (Rugala & Waldo, 1998). According to Yalom (1980), an existential therapist, "It is the relationship that heals" (p. 401). By carefully listening to the stories of adolescents without negative judgment, responding genuinely to those stories, and gently probing for greater clarity, MHCs create a safe environment that honors clients' or adolescents' experiences.
In addition to listening, the MHC can also share relevant experiences. For example, as the therapeutic relationship has developed, I have sometimes shared my experience of being in an accident and being left with chronic pain. I share the fact that following my accident I felt that my life would never be as good as it was before. Nonetheless, I struggled to make sense of my pain; and through this struggle, I decided that if my pain could serve some purpose, it would be easier to bear. Initially, I relate that I decided to work with others with physical pain and felt that the ways I had learned to cope might be helpful to others in coping with their pain. Over time I decided that working with individuals struggling with depression would also provide a purpose to my pain. I relate that I perceived that depression represented emotional pain and that my struggles with physical pain would be somewhat similar to the struggles others have had with depression. My purpose in sharing this experience is to show my own struggle in trying to find meaning in my circumstance, noting that meaning was not readily apparent, but that over time, I was able to discover it. Through this sharing, I note that although the struggles we encounter often have common themes, they are unique to us, and the meanings we discover will also be distinct.
Increasing Insight Regarding Identity, Values, and Goals
As the therapeutic relationship develops, adolescents slowly begin to feel understood and safe in the counseling environment, frequently becoming more willing to risk personal exploration and sharing what they really think and feel. As the MHC reflects and gently probes the experiences being shared, adolescents gain insight into the meaning of those experiences and how their perceptions influence that meaning.
Logotherapy puts great emphasis on the inevitability of suffering. Incorporating this theory, Lantz and Gregoire (2000) state that it is important to honor the pain of the client by helping each to "hold, and express the pain that he or she has endured" (p. 23). Therefore, adolescents are encouraged to become more aware of their pain and, then, to fully express that pain.
Following exploration of the client's experiences and pain, dialogue can then address the adolescent's dreams and aspirations. As these are explored, Luntz & Gregoire (2000) state that the MHC should remain open to the potentials of the adolescent by not setting limits as to what can be accomplished. Rather, the MHC assists and encourages adolescents in identifying and exploring their dreams and developing goals, which if accomplished, will lead to the fulfillment of those dreams. Through this exploration adolescents are helped to define and connect with what they truly desire. This future orientation assists adolescents in identifying a freely chosen meaning that they gradually clarify and move towards (Guttmann, 1996; Luntz & Alford, 1995). Highlighting the importance of identifying meaning, Frankl (1967) states: "Man's life is put in order through his orientation toward meaning. Thereby a field of tension is established between what man is and what he ought to do" (p. 35).
In exploring the possible future of an adolescent's life, logotherapy incorporates Socratic dialogue, asking questions designed to "give birth to the truth" residing in the "souls" of those being asked (Guttmann, 1996, p. 141). Through this dialogue, the MHC poses questions as if naive to their answers, thereby requiring adolescents to search within to discover answers. Incorporating this method, the following questions might be asked: What is it that you hope to get from life? What would have to happen in order for you to be content? what lifestyles have you considered and which of these lifestyles seem most likely to provide you with long-term happiness? As the adolescent ponders these questions, the MHC encourages the youth to think broadly and without restriction, when answers are not readily available, the MHC does not provide them; rather he or she encourages the adolescent to search deeper within, trusting that the best and most appropriate answers lie within.
Socratic dialogue can also be used to elicit information about the strengths and talents of adolescents, what do they perceive to be their talents and how can these be developed? What goals or aspirations have they considered for their various talents? As goals and aspirations are discussed, adolescents can be encouraged to clarify them and identify specific ways that their talents can be developed and utilized in the fulfillment of their goals. As answers are given, the MHC listens carefully to the tone of the responses, noting which are most animated and asking further questions about those responses. For example, while counseling with an adolescent female and discussing her future and the type of work she wanted to do, I explored with her the various possibilities with minimal animation shown by the client. However, when the subject of working with animals was mentioned, she smiled and began talking more excitedly. Responding to her reaction, I stayed focused on animals, and, together, we identified the various ways she could work with them. By carefully listening to the tone of responses and targeting those that appear most animated, adolescents are assisted in exploring and connecting with their deepest desires and unique natures. This targeting also emphasizes that the best goals and dreams are freely chosen and originate from within.
As strengths, talents, and goals are explored, adolescents gain insight into their capabilities and desires. This insight can later be used as a guide to discover meaning, helping them explore possibilities that correspond to their capabilities and interests. However, discussing future goals with depressed adolescents often necessitates additional time because they typically feel as if life has lost any sense of meaning. Feeling exhausted and overwhelmed beneath the anguish of depression, they frequently discount their own talents and other resources, discussing what they want, but doubting or refusing to believe that it can be accomplished. To counter this tendency, De Jong & Berg (2002) suggest asking questions that encourage a different perspective in self-examination. For example, when youth struggle in identifying their positive aspects, I might ask: "If I were to ask your mother about your talents, what would she say? If your best friends were to describe your strengths, what would they say?" These questions encourage a fresh perspective and frequently assist the youth in identifying a few talents.
Once a variety of goals and talents has been identified, questions can then be asked about the resources needed to attain them, such as: What would have to happen in order for you to achieve this goal? What could you do, or are you doing, in order to move towards the accomplishment of this goal? And, who might be of assistance in your achieving this goal? By asking questions about specific goals, adolescents are helped to estimate the effort needed to attain each goal, thereby determining which are attainable and what effort and resources are needed (Dejong & Berg, 2002).
Once adolescents have the opportunity to express their pain and to explore goals, they are often more willing to accept the MHC's refraining of depression; and as it is refrained, the adolescent may begin to perceive it differently. In reframing depression I often use the analogy of physical pain, noting that pain often serves as a signal that there is something wrong with the body. Similarly, I posit that depression can be viewed as emotional pain that also contains a hidden message that something is out of balance. I note that if one is able to discover the cause of the imbalance and make changes to achieve balance, the depression will lessen or disappear. I emphasize that the challenge is in identifying both the causes of the depression and the unique meaning behind it. Noting that once causes are identified, behavioral, biological, and attitudinal changes can then be made that reduce or eliminate the cause. Concurring with this view, Bresler (1979) states:
Accept your pain as a friend, not an enemy, and begin to work with it, rather than against it. For as you come closer to discovering and resolving the unknown problems in your life, your nervous system will tell you so by reducing your discomfort or by turning it off altogether. (p. 70)
When depression is reframed as purposeful, it becomes more bearable, warning the individual that some change or a variety of changes are needed; therefore, the individual is more willing to bear its effects while searching for its cause. In accord, Frankl (1967) notes that, "when suffering has a purpose, it ceases to be suffering" (p.65). Thus, the severe pain of depression, described "as one of the most debilitating and painful human experiences" (Munoz & Ying, 1993, p. 16) may also increase the adolescent's willingness to make difficult personal changes in order to escape its anguish.
Through collaborative exploration, the MHC and adolescent search out potential causes of the depression. Some adolescents, with the help of a MHC, may find that a prominent cause of their depression is a chemical imbalance requiring medication to remedy; others may find that it results from a conflict of values and behavior. Still others may discover that cognitive distortions exacerbate their depression. Of the myriad of possible causes to depression, the MHC and adolescent work together in pinpointing its source.
Discovering Meaning Within the Depression
However, identifying and addressing causes is only a minor step in the treatment process. As previously noted, logotherapy places its emphasis on the assumption that depression and other pathology frequently result when individuals are living below their potential. In other words, as individuals fail to discover and pursue meaning and meaning potentials in their lives, they become vulnerable to depression (Lantz & Alford, 1995). Consequently, logotherapy underscores the adolescent's responsibility to discover and pursue the meaning potentials within the self. According to Frankl (1967), "if therapists wish to foster their patients' mental health, they should not be afraid to increase the burden of one's responsibility to fulfill the meaning of his existence" (p. 76).
To promote a search for meaning in depression, I might say to my client: "despite the pain and suffering of your depression, let's assume that it also represents a sign that you're living below your potential, that something needs to be added or subtracted from your life. Yet only you, after close self-examination, can determine what that something is. My role is to assist you in your search for meaning. But because of your unique nature and abilities, the meaning hidden within your depression will be personal and distinct." I note that the search for meaning will likely be more personal and difficult than the search for causes of depression, emphasizing that the discovery of meaning will likely require profound evaluation of their values and priorities, their dreams and aspirations, and the choices they have made. As youth search within themselves and ponder the possible meaning of their depression, they often recognize changes that need to be made. Although the search is collaborative, the MHC only guides the adolescent towards discovery; the adolescent must ultimately decide what the depression means for him or her. And once meaning is discovered, the adolescent and MHC work together to plan the changes that will lead to the fulfillment of that meaning.
To assist in the discovery of meaning, Bresler (1979) suggests writing a letter to the pain of depression as a way of beginning to understand its message. Incorporating this letter writing method, I counsel adolescents to vent their frustrations on the depression by expressing how much pain and suffering it has caused. I encourage them to note the specific ways that depression has affected them. Once they have done this, I advise them to think about the possible reasons why they are currently depressed, and then to write a second letter from the point of view of their depression, as if their depression were returning their correspondence and trying to convey its purpose.
Having adolescents with depression write these letters serves a couple of purposes. Primarily, it helps to clarify the numerous ways that depression has affected them. By including specifics, they frequently recognize the pervasive and profound nature of their depression. And by taking the time to examine their frustrations and pain, and through writing those difficulties down, they often feel purged of some of that pain. The second letter helps to reframe the meaning of depression. Rather than being the enemy and something dreaded, the depression is reframed as something to learn from. As noted earlier, when depression is viewed as purposeful, it becomes easier to bear. Once that has been accomplished, the adolescent is more apt to face the depression and endeavor to learn from it. Suggesting a purpose in pain, Young-Eisendreth (1996) states, "before quelling suffering with prescription or nonprescription drugs, we would do well to enter its terrain and walk around a bit" (p.49).
In searching for meaning, there are no right or wrong answers, The goal is not just to develop a deeper understanding of oneself and the elements of one's lifestyle that create happiness or sadness, but rather to identify a distinct and worthy meaning that can act as a beacon in guiding the adolescent towards fulfillment. However, the discovery of meaning does not complete the therapeutic process; the adolescent is still responsible for actualizing that meaning (Frankl, 1984).
Pursuing the Fulfillment of Meaning
Once meaning has been discovered it can be used as a gauge in determining which behaviors and attitudes to pursue. Those that lead towards its attainment can be pursued; whereas behaviors and attitudes that lead away can be released. Nonetheless, despite being able to identify a meaning, adolescents often need assistance in identifying the steps needed to more from their current position to the fulfillment of that meaning. Therefore, working in collaboration, the MHC helps the adolescent (a) identify the needed changes, (b) break the changes down into manageable components, and (c) progressively implement changes that streamline and focus him or her towards the fulfillment of meaning.
Goals and aspirations that were previously discussed can now be modified to augment the pursuit of meaning. To facilitate manageable change, questions can be posed that assist the adolescent in partializing the process of change. For instance, I might ask: What are the various steps needed for you to achieve this meaning? If you were to identify your stage in the process, what step would you say you were at? What is needed for you to move to the next step? And, what are you currently doing or not doing that is slowing the fulfillment of your meaning? As an example of this probing, after a male adolescent expressed a desire to serve the healthcare needs of the homeless in his community by becoming a doctor, I noted that he was not currently attending school and was failing all of his classes. Hence, I asked the following: What are the steps needed to become a doctor? And, what are you doing that is moving you towards that destiny or away from it? As he thought about and answered these questions he gained greater insight into how his current behaviors were impacting his future. As his insight grew, he became more willing to modify behaviors that were in conflict with his chosen meaning.
As adolescents identify a meaning to pursue and modify their behaviors to move towards that meaning, they often notice progress being made toward the desired outcome. Frequently they become aware of further changes that can be made to speed their advancement. Pursuing meaning also helps provide a clear sense of direction and an increasing awareness of the freedoms and choices they possess. In the words of Young-Eisendreth (1996), "when understood well, painful experiences awaken us to new meaning and purpose" (p. 13). By helping adolescents face depression, and assisting them in questioning it as to its possible meanings, mental health professionals empower them to view depression in a new light and to discover answers that could not be found from a deficit perspective.
This pursuit and, hopefully, the eventual attainment of meaning are most always difficult and time consuming because habitual ways of coping are recurrently in opposition to the meaning being pursued and must be modified in order to achieve the identified meaning. Overcoming habits is laborious and fraught with setbacks. Nonetheless, by assisting adolescents in maintaining their focus on their chosen meaning, providing encouragement and support, and not giving up, the MHC facilitates the achievement of meaning.
Logotherapy further posits that one is not only free to choose but responsible for making choices that are conducive to growth. According to Frankl (1967), "What man needs is not a tensionless state but the striving and struggling for something worth longing and groping for" (p. 75). Therefore, the meaning adolescents discover must be beyond their current reach, encouraging the stretching of abilities in order to attain the desired meaning. Additionally, Frankl (1986) notes that, "Human existence always points, and is directed, toward something other than oneself or, rather, toward something of someone other than oneself ... and only to the extent to which a human being lives out his self-transcendence is he really becoming human and actualizing himself"(p. 294).
Self-transcendence implies that as adolescents discover and pursue meaning, they should move to higher levels of self-understanding and responsibility. Accordingly, the meaning they pursue should relate to future goals and lead to a greater understanding of their life purpose. Moreover, as meaning is pursued, their value system should guide that pursuit, directing them as to which methods are the most appropriate. As adolescents maintain their value system while pursuing a worthy meaning, they gain an increase in inner harmony and self-understanding. Concurring, Shantall (1999) notes that if an individual faced with a difficult challenge "had the courage to choose a course of action that seemed dictated by his of her own conscience as the morally right or courageous thing to do ... these choices had a sustaining effect on them. They felt imbued with a very real sense of meaning" (p.110).
As adolescents increasingly understand their values, goals, strengths, and weaknesses, they are better able to derive meaning from their depression. As they discover and pursue the fulfillment of that meaning within their value system, they further increase their self-understanding and begin to discover new and higher levels of meaning. Consequently, through searching out and pursuing meaning, the adolescents existential vacuum begins to shrink, and they experience a lessening of their depression. As they discover and pursue higher levels of meaning, their existential vacuum shrinks further, and the depressive symptoms associated with that vacuum are further reduced or eliminated.
In searching for a unique meaning behind depression, clients commonly obtain answers that are more personal and helpful than answers that I could provide as a MHC. For example, in a lock-down residential setting, working with one 17-year-old with symptoms of depression, we discussed his pain as well as other problems he was experiencing. To assess the severity of Iris depression, the Beck Depression Inventory (BDI) was used. On a weekly basis, over a 3-week period, this adolescent scored an average of 40 on the BDI, indicating severe depression (Beck, Steer, & Brown, 1996; Burns, 1980). Reviewing his scores on the BDI and verbalizing his various problems, he further recognized the enormous weight of his depression. Following this 3-week period, after we had developed rapport, I assisted him in reframing the meaning of his depression by asking him to think about its possible meaning, and then asking: "Let's assume that your depression is purposeful, that it's trying to convey a message to you, telling you that some change needs to be made in your life. Your job is to figure out what that change is, and then to make it." After taking sufficient time to think, he responded that he had always wanted to read philosophy but had never taken the time to do so. We discussed some of the titles he wanted to read, and when the book Atlas Shrugged (Rand, 1996) was mentioned, he became excited and decided that was the book he would read. He purchased and read the book. Within a 2-week period, and with no additional interventions, his score on the BDI dropped to 10, indicating a normal mood range (Beck et al., 1996; Burns, 1980). Over the next 2 weeks, further weekly assessment was sustained and my client continued to score an average of 10 on the BDI. According to Beck et al., the magnitude of this pre-post change, dropping from an average of 40 to an average of 10, indicates a reliable, clinically significant change.
As a MHC, reading philosophy never would have occurred to me as a possible meaning behind depression; yet trusting my client and his ability to discover for himself, allowed for the rapid reduction of his depressive symptoms. In further conversations, he mentioned that reading allowed him to begin to see what he could do within the limitations of his depression and Iris environment, noting that although he was confined to a lock-up facility, he still had a variety of freedoms, including the freedom to select the literature he wanted to read. The simple act of choosing and reading a book seemed to awaken him to the choices he had. Despite being confined, my client's search for meaning allowed him to reframe his attitude towards that confinement. As he recognized the choices he had and began taking responsibility for them, his attitude became more optimistic, and his depressive symptoms lessened. My client's changed response to his circumstance conforms to beliefs of logotherapy; according to Frankl (1967), "Man is not free from conditions ... He is and always remains free to take a stand towards these conditions, retaining his ability to choose his attitude towards these conditions" (p. 19).
With a lessening of my client's depressive symptoms, we spent more time exploring his future dreams and aspirations and discussed which of these potential meanings he hoped to realize. Through this discussion he was able to identify a few specific meanings and began working towards their fulfillment. As he did so, his depressive symptoms lessened further. Nonetheless, despite progress, my client had several setbacks in his behavior that resulted in a loss of privileges. As his mental health counselor, I continued to address his discovered 'meanings and the behaviors which would move him towards their fulfillment, emphasizing that he was free to choose but also responsible for his choices. As his depression lessened, his insight also grew. After one home visit he revealed that while home he discovered a cache of his mother's alcohol. When the opportunity to imbibe presented itself, he said that he tried to resist but could not and drank himself into a stupor. He mentioned that this inability to resist scared him and that he recognized he was an alcoholic. Together we discussed the probable impact of alcohol on the meaning he had discovered. I provided various questions, and through his answers my client explored alcohol's likely impact. By allowing my client to hold his discovered meaning as a beacon, by asking questions about the impact of various behaviors on that meaning, my client became more willing to critically evaluate and discontinue some of his negative behaviors.
During a subsequent home visit my client stated that he had the chance to observe his mother and her interactions with him and concluded that she did not love him. I questioned him regarding the reasons for his conclusions but refrained from pushing my own judgments. I listened carefully to what he had to say and the anguish behind his words. His conclusions seemed reasonable; so I did my best to honor the pain he was feeling and to help him express that pain. Over time I asked more questions regarding his relationship with his mother, and through his answers, he was able to critically evaluate both his mother's behavior and his responses to that behavior. Through this evaluation, he began to perceive that many of his past behaviors had been designed to either please his mother of to get back at her. With this insight, my client was able to begin breaking free from trying to please or hurt her. He became more willing to consider the meaning potentials within him and to ponder the changes he needed to make to achieve these potentials. As he did this, he began accepting greater responsibility for his own choices and reacted less often to his mother's choices.
In another case example, while working with one depressed young mother who had just discovered that she was HIV positive, we discussed the difficulty of facing likely death at a young age and the probability of dying while her children were still young. As she grieved the loss of the years she had thought she would have, she began to perceive the preciousness of the limited time she still had remaining. I asked, "How could the remaining time you have be optimally used?" After serious contemplation, she answered that she wanted to be the best mother to her children for whatever time she had left. As this was mentioned, we discussed what it meant to be a "good" mother, what changes she would need to be make, and how she could improve her capacity to care for her children.
My client struggled with a few addictions and had difficulty providing adequate care to her children. During our time in counseling, she was arrested for shoplifting and investigated for child neglect. Addressing the choices she was making, we talked about freedom and responsibility, the freedom to choose her behaviors, and the responsibility for the choices she made, noting that the consequences of her recent actions might result in the loss of her children. Recognizing the gap between what she was doing and what she hoped to be doing, she seemed revolted by her current performance. Shifting the conversation, we discussed ways that she was caring for her children and together brainstormed small ways in which she could move toward her desired goal without berating herself for not already being there. Slowly, by allowing the meaning she had discovered to guide her, by taking responsibility for her choices, and by continually making small changes that built on each other, she was able to make some progress in her chosen meaning: being the best mother she could to her children.
In summary, logotherapy for depressed older adolescents can be empowering because it puts the responsibility of understanding and learning from depression on the adolescent. The MHC does not rescue adolescent clients but rather works in a collaborative relationship assisting them in the discovery and pursuit of a unique meaning associated with their depression and life. In support of this model, Brown & Romanchuk (1994) posit that, as individuals, we are in a "process of becoming and can be assisted in finding meaning in life and with assistance may move to a higher level of authenticity" (p. 51). Additionally, as the meaning of depression is identified and pursued, adolescents often gain understanding regarding their values, unique nature, and the current meaning of their lives.
The goal of logotherapy is not necessarily the alleviation of depression: rather it is the discovery and pursuit of a worthy meaning. Nonetheless, as adolescents discover and pursue meaning, they have little time to dwell on depressive symptoms, resulting frequently in a dissipation of those symptoms. In other words, as adolescents discover meaning in depression, their focus is taken off the depressive symptoms and focused instead on the meaning being pursued. As this focus is maintained, adolescents experience a shrinking of their existential vacuums and a lessening of their depression. The MHC facilitates the discovery of meaning by providing emotional support and by the use of Socratic dialogue. Once meaning is discovered, the professional supports and encourages the active pursuit and fulfillment of that meaning. According to Frankl (1967), "man is responsible for the specific meaning of his personal life ... If we take man as he is, we make him worse; if we take him as he ought to be, we help him become it" (p. 27).
Allen-Meares, P. (1995). Children: Mental health. In R. L Edwards (Ed.), Encyclopedia of social work (19th ed., pp. 460-464).Washington DC: National Association of Social Workers,
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory (2nd ed.). San Antonio, TX: Psychological Corp.
Bresler, D. D. (1979). Free yourself from palo. New York: Simon & Schuster.
Brown, J. A., & Romanchuk, B. J. (1994). Existential social work practice with the aged: Theory and practice. Journal of Gerontological Social Work, 23, 49-65.
Burns, D. D. (1980). Feeling good: The new mood therapy. New York: Avon books.
Corey, G. (2001). Theory and practice of counseling and psychotherapy (6th ed.). Pacific Grove: Brooks/Cole.
De Jong, P., & Berg, I. K. (2002). Interviewing for solutions (2nd ed.). Pacific Grove: Brooks/Cole.
Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton.
Frankl, V. E. (1967). Psychotherapy and existentialism: Selected papers on logotherapy. New York: Simon & Schuster.
Frankl, V. E. (1984). Man's search for meaning (3rd ed.). New York: Simon & Schuster.
Frankl, V. E. (1986). The doctor and the soul: From psychotherapy to logotherapy (2n ed.). New York: Vintage Books.
Guttmann, D. (1996). Logotherapy for the helping professional: Meaningful social work. New York: Springer.
Hanna, F. J., Hanna, C. A., & Keys, S. G. (1999). Fifty strategies for counseling defiant, aggressive adolescents: Reaching, accepting, and relating. Journal of Counseling and Development, 77, 395-404.
Krill, D. F. (1996). Existential therapy. In F. J. Turner (Ed.), Social work treatment (4th ed., pp. 250-281). New York: Free Press,
Kutcher, S. (1997). Practitioner review: The pharmacotherapy of adolescent depression. Journal of Child Psychology and Psychiatry, 38, 755-767.
Lantz, J., & Alford, K. (1995). Existential family treatment with on urban-Appalachian adolescent. Journal of Family Psychotherapy, 6, 15-28.
Lantz, J., & Gregoire, T. (2000). Existential psychotherapy with Vietnam veteran couples: A twenty-five year report. Contemporary Family Therapy, 22, 19-36.
Munoz, R. F., & Ying, Y. (1993). The prevention of depression: Research and practice. Baltimore MD: Johns Hopkins University.
Pellebon, D. A., Anderson, S. C. (1999). Understanding the life issues of spiritually based clients: Families in society: The journal of contemporary human services, 80, 229-238.
Rand, A. (1996). Atlas shrugged. New York: New American Library.
Rugala, S. A., & Waldo, M.(1998). An integration of existential psychology and the multimodal model. The Journal of Humanistic Psychology, 38, 65-79.
Shantall, T. (1999). The experience of meaning in suffering among Holocaust survivors. Journal of Humanistic Psychology, 39, 96-124.
Yalom. I. D. (1980). Existential psychotherapy. New York: Basic Books.
Young-Eisendrath, P. (1996). The gifts of suffering: Finding insight compassion and renewal. New York: Addison-Wesley.
Zastrow, C., & Kirst-Ashman, K. K. (1997). Understanding human behavior and the social environment (4th ed.). Chicago: Nelson-Hall.
Robert G. Blair, Ph.D., is an assistant professor, Department of Social Work, New Mexico State University, Las Cruces. E-mail: firstname.lastname@example.org
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|Author:||Blair, Robert G.|
|Publication:||Journal of Mental Health Counseling|
|Date:||Oct 1, 2004|
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