Logotherapy for Substance Use Treatment
An excerpt from Meaning of Life Group: Group Application of Logotherapy for Substance Use Treatment (Somov, Journal for Specialists in Group Work, 2007, 32 (4), 316 – 345)
Rationale for Using Logotherapy in the Context of Substance Use Treatment
In delineating the scope and goals of logotherapy, Frankl (1955) juxtaposed it with psychoanalysis by defining it as “existential analysis” that “seeks to bring to awareness the concepts of the mind,” in the goal of helping the client “toward the consciousness of responsibility” as “being responsible is one of the essential grounds of human existence” (1955, p. 29). Existential review, search for meaning, and assuming responsibility are pivotal to the substance use recovery arc.
Recovery, in itself, is not a goal, but a means to a goal, a means to facilitating a meaningful life. Consequently, the Meaning of Life Group is an attempt to help clients place their substance use in the existential context. Lukas (1979) notes that upon completion of treatment, substance use clients are likely to “ask themselves if there was any sense of their being cured and what they will do with the life that was restored to them” (p. 263). Indeed, a person coming out of an otherwise successful rehabilitation may ask of him or herself, “Ok, so I got clean… Now what?!”
Leaving this question unanswered seems to be an invitation to relapse. While incentive-based motivations can help a client initiate a change, a meaning-based motivation may assure the maintenance of clinical gains. Consequently, clients are invited to start the recovery process by taking a look beyond the recovery, beyond the myopia of “getting back on track,” towards the destination of the life-track. This is accomplished by priming clients’ consciousness with the “meaning of life” questions, i.e. existential and philosophical questions that allow clients to broaden their motivational search from short-lived, tactical, and often cliché motivations to person-specific, meaning-centered motivations that serve as a buffer against the turbulence of change.
Logotherapy can help normalize the angst of recovery as a normal existential “vital sign.” When clients are asked to ponder the interplay between meaninglessness (the all too familiar feelings of emptiness) and substance use, they are offered a normalizing, de-pathologized perspective on substance use as an escape from meaninglessness and a legitimate albeit sub-optimal form of trying to resolve noogenic neurosis or noogenic depression (Frankl, 1978).
As such, the Meaning of Life Group introduces validating existential language into motivational enhancement that frees the client from the paralysis of self-deprecating guilt and refocuses the client on regaining meaning through recovery.
The Meaning of Life group protocol attempts to awaken the philosopher inside a given client, providing a substance use client with an opportunity to strategically zoom out, to reset his or her existential compass, to place both substance abuse/misuse and recovery in the trajectory of one’s life journey, to resuscitate the anesthetized and deadened will-to-meaning in the hope of giving recovery more than tactical importance. As such, logotherapy in the context of substance use treatment not only facilitates motivation for change but also serves as an important lapse/relapse prevention factor.
There is more to life than recovery. Recovery is but a means to an end, not an end in and of itself. Clients for whom recovery becomes an end in and of itself are at added risk for relapse should they lapse in the first place. And, indeed, if being in recovery has become a defining part of one’s narrative, if recovery has become an end in and of itself, catastrophizing interpretations of a lapse (as an end of everything that matters) are inevitable, and so is a relapse.
This can be best understood in terms of Linville’s (1985) research on self-complexity. Linville (1985) suggests that narrowly defined self-concepts are less stable than self-concepts that consist of multiple roles that are well differentiated from each other. Metaphorically, stable self-concepts are like submarines that are buffered from sinking by the fact that they consist of multiple hermetically separated compartments which isolate a leak in a given compartment from the rest of the submarine, allowing even a damaged, leaking submarine to remain afloat.
A person in recovery whose life consists of multiple well-differentiated meanings, for whom recovery is but one of several means to a particular life-goal, would appear to be better buffered from stress and psychological “sinking” than a person in recovery who has turned recovery into a life-long cause and found a life’s meaning in staying “clean.” Life-long recovery-oriented socialization, life-long self-definition as an “addict” or as always “recovering” or through “years clean,” or excessive enmeshment of recovery and spirituality, run the risk of a single-track self-concept with recovery turned into a life’s meaning.
When the treatment goal of recovery becomes a life goal, little leaks (lapses) become gushing catastrophic floods (re-lapses). Consequently, logotherapy, in addition to priming and enhancing motivation for change, can be invaluable in relapse prevention by helping substance use clients not substitute a narrow self-concept of an “addict” with a similarly narrow self-concept of being “a recovering addict.”
Meaning of Life Group Format
The Meaning of Life Group is a professionally-facilitated, secular, content-based, structured group that raises questions, facilitates a non-judgmental discussion of various issues of existential significance, and involves various experiential exercises. While the content is philosophical in nature, intellectualizing is discouraged.
Facilitators follow the method of Socratic inquiry, a discourse method of preference in logotherapy, the goal of which is not “to pour information into the students, but rather to elicit from the students what they already know intuitively” (Fabry, 1988, p. 9). In this process, facilitators are encouraged to remain attuned to what Fabry referred to as “logohints,” or phrases, facial expressions, intonations that indicate “what is meaningful to the seeker,” clues to clients’ “positive attitudes and values” (1988, p. 12). Furthermore, facilitators do not educate but facilitate clients’ self-discovery; facilitators do not provide meaning but point out “meaning possibilities” (Fabry et al, 1979, p. 265). As noted by Lukas (1979), the final responsibility for the found meanings and their implications rests with the clients.
Facilitators remain mindful of the natural interplay between meaning and spirituality, but avoid direct discussion of religious topics, redirect clients’ from direct questioning of fellow group members’ religious pronouncements and defer direct discussions of religious beliefs to more appropriate non-secular forums. The facilitators, of course, avoid imposing their values or endorsing others’ values with the emphasis of the group being on raising the questions, rather than on answering them. Facilitators explicitly recognize and help clients recognize that while there might be the question, there isn’t always the answer.
The Eight Theme Curriculum
Frankl (1955), discussing the scope of logotherapy as existential analysis, emphasizes the exploration of meaning of life, meaning of death, meaning of suffering, meaning of work, and meaning of love. The following are eight discussion themes that structure the curriculum of the Meaning of Life group:
Theme 1: Meaning of Meaninglessness
Theme 2: Meaning of Adversity
Theme 3: Meaning of Self
Theme 4: Meaning of Presence
Theme 5: Meaning of Death
Theme 6: Meaning of Freedom
Theme 7: Meaning of Substance Use
Theme 8: Meaning of Transition
Ref: Meaning of Life Group: Group Application of Logotherapy for Substance Use Treatment (Somov, Journal for Specialists in Group Work, 2007, 32 (4), 316 – 345)
Tracks in the sand photo available from Shutterstock
Somov, P. (2012). Logotherapy for Substance Use Treatment. Psych Central. Retrieved on February 8, 2016, from http://blogs.psychcentral.com/mindful-living/2012/08/logotherapy-for-substance-use-treatment/