Paul T. P. Wong & Lilian C. J. Wong
An edited version will appear in Emmy van Deuzen and Susan Iacovou (Eds). Existential Perspectives on Relationship Therapy. Palgrave Publisher
All the evidence on effective psychotherapy has confirmed that relationship heals regardless of what therapeutic approach is employed (Duncan, Miller, Wampold & Hubbel, 2009). However, from a humanistic-existential framework, relationship goes beyond building rapport and therapeutic alliance; the curative effect of relationship can only be fully understood in terms of Rogers’s (1951) preconditions for effective therapy: empathy, genuineness, and unconditional positive regard as personal qualities of the therapist. These preconditions create a positive and safe environment in which clients are free to share their deepest fears as well as explore risky new options.
Furthermore, duPlock (1997) emphasizes that existential therapy cannot be separated from the therapist as a person. In fact, existential therapy can be defined by the presence of the therapist. It is the therapist’s Being that illuminates what it means to be a good human being and how to care for each other in a world full of darkness and troubles. The I-Thou relationship (Buber, 1923/1970) involves authentic encounters, which imply authenticity and bonding in the therapeutic situation (Bugental, 1990; May, 1999). In each here-and-now encounter, information and energy flow back and forth between two human beings. Each encounter reveals the phenomenological experiences and the frame of reference of the client, and opens up opportunities to connect with the client in a life changing way. Since feelings of displacement, estrangement, and alienation often contribute to client’s problems, the therapeutic relationship not only provides an antidote to loneliness, but also renews a sense of connectivity and belonging.
In sum, existential therapy operates in an interpretative world as well as a relational world (Spinelli, 2007). The goal of existential therapy is to empower clients to have the courage and freedom to move from the security of an unpleasant status quo to embracing the risks of creating a preferred future. This therapeutic goal is achieved primarily through authentic encounters. The existential approach is uniquely suitable for marriage and couple therapy because of its emphasis on the process of change through relationship and communication.
Meaning therapy (MT) is also known as meaning-centered counselling and therapy or existential positive psychotherapy (Wong, 2009, 2010) because of its explicit growth orientation and its emphasis on meaning-making. It affirms that hope and positive meaning can be found in every situation. MT is rooted in the humanistic-existential tradition, but is also based on logotherapy, cognitive behavioral therapy (CBT) and positive psychotherapy. MT is inherently cross-cultural to the extent that meaning is socially constructed. The motto of meaning therapy is “meaning is all we need, relationship is all we have.” MT as a unique brand of existential therapy is primarily psychological rather than philosophical.
A big part of meaning therapy (Wong, 2010) is to work on the psychological process of meaning-seeking, meaning-making and meaning-reconstruction. In terms of attributing meaning to events, MT recognizes both causal attribution and existential attribution (Wong, 1991; Wong & Weiner, 1981). CBT skills are employed to challenge and correct misattributions of causality of personal problems. Existential interventions are used to address existential anxieties, and worldviews and beliefs. But the main focus of MT is on empowering clients to choose congruent communication (Satir, Banmen, Gerber, & Gormori, 1991) as well as to use available resources to create a more rewarding married life.
The two major psychological intervention strategies of MT are PURE and ABCDE. PURE stands for Purpose, Understanding, Responsible action and Enjoyment–the four facets of meaning in life. PURE provides an effective framework for clients to make sense of their own lives in the world and make responsible choices. PURE is equally important for making meanings congruent with others and the situation. ABCDE stands for Acceptance, Belief, Commitment, Discovery and Evaluation–the five steps to cope with problems, especially those predicaments and dilemmas that cannot be resolved by human effort. ABCDE focuses on commitment to responsible actions.
Positive-Oriented Relational Therapy
The main modality of MT is relational. MT assumes that we are relational creatures with the basic need for belonging and attachment (Bowlby, 1988; Bugental, 1999; Yalom, 1980; Wong, 1998a, 1998b). In addition to addressing interpersonal deficits experienced by the clients (Weissman, Markowitz, & Klerman, 2000), MT also equips clients with the necessary skills to build and maintain positive relationships. Good and open communication is an essential clinical tool to bring clarity and resolution to personal predicaments. However, MT elevates communication to a new level. A great deal of therapy time is spent in making explicit the implicit meanings and hidden needs that contribute to the marital conflict. Given the emotion-laden quality of couples’ communication, especially in unpleasant and stressful situations, MT will emphasize the importance of viewing the problem from different perspectives in order to reduce emotional intensity and achieve congruence.
The immediacy technique is used during the session to draw attention to misattributions of meaning and failures in communication in order to learn new patterns of relating. Couples will also learn that by shifting perspectives and changing their own frame of reference, they will be able to choose more congruent attitudes and feelings towards each other.
Couples will learn different levels of active listening. They need to learn not only to listen with their ears and eyes but also with a compassionate heart and an open mind. Finally, they need to listen with their spirit, to be attuned to each other’s silent cry for meaning and understanding. Spirituality is the core of personhood (Deurzen & Adams, 2011). To communicate at the spiritual level is to understand each other’s spiritual essence and inner space (Satir et al,.1991). By demonstrating all five levels of listening–ear, eye, heart, mind, and spirit–the therapist models for the couple how to be totally and honestly engaged in congruent communication.
Lantz (1996) emphasizes the importance of making use of the meaning potentials in intimate relationships. Similarly, Hendrix’s (2010) Imago Relationship Therapy teaches couples to replace confrontation and criticism with a reciprocal process of healing, which primarily consists of basic communication skills such as Mirroring (i.e., reflecting accurately), Validating, and Empathizing. In addition to equipping clients with basic communication skills, MT also employs PURE and ABCDE interventions to facilitate congruent communication.
The PURE Intervention Strategy
The PURE strategy provides a framework for marital therapy and effective communication, because each component represents an essential building block in improving relationships and changing lives.
Purpose. Purpose refers to directions, goals and objectives. The most important factor for a successful marriage is that the couple enjoys shared meaning and purpose (Deurzen, 2010; Gottman, 1998), while remaining authentic to themselves. It is difficult to plan life together when the couple has conflicting life goals and priorities. One also needs to bear in mind that the purpose of couple communication is not just to make one’s own needs known to the other, but also to understand each other’s needs, feelings, and frame of reference in order to grow together.
Understanding. Congruent communication involves making sense of self, others and events in a way that promotes harmony and personal growth. The key to MT is to teach clients that the personal meaning they attach to an event has greater impact on them than the event itself. Therefore, events and people do not cause them to be angry; it is the meaning they attach to the events and people that makes them angry. While clients are entitled to believe in the verity of their own perceptions, it is necessary for them to explore alternative interpretations that are congruent with the other in order to resolve an impasse and move forward.
Responsibility. Clients are responsible for the meaning they make, the attitude they hold, and the action they take. They are also responsible for the negative consequences of defending the truthfulness of their own perceptions and attacking the falsehood and biases of the perceptions of the other. To decrease conflict and negative emotions, couples are reminded that they are responsible for caring for each other’s well-being and creating a rewarding future together through congruent communication.
Enjoyment. No relationship can last long if it is totally devoid of joy and positive reinforcement. The practice of Purpose, Understanding, and Responsibility should decrease the frequency of negative communication and increase mutual understanding and positive interactions. But couples also need to intentionally create opportunities to have a good time together.
This strategy focuses on repairing what is wrong, while the PURE strategy focuses on bringing out what is right. In therapy, these two interventions are typically employed together to facilitate congruent communication and positive transformation.
Acceptance. Acceptance is the first step towards reparation of broken relationships; it is also the most important component of congruent communication. Clients need to accept life as it is–the good, the bad, and the ugly. Couples need to accept one another’s feelings and failings, and work towards congruent understanding. If one party denies his or her culpability and completely blames the other, the conflict will escalate. Accepting cultural differences between East and West in expressing emotions (Hoffman & Cleare-Hoffman, 2011) can facilitate communication in cross-cultural marriages.
Belief. Hope is essential for healing and growth. Couples need to believe that their marriage is worth saving and their problems are solvable. If one party is already dead-set on divorce, it is very unlikely that the marriage can be saved.
Commitment. It takes commitment and hard work to correct bad habits. It takes time and effort to rebuilt trust and repair broken relationships. Marital therapy will work only when both partners are committed to making the necessary changes to save a marriage and improve congruent communication. Chinese history has shown that commitment to the family values of harmony and self-sacrifice helps keep the family together (Dias, Chan, Ungvarsky, Oraker, & Cleare-Hoffman, 2011).
Discovery. Human beings are complex and constantly evolving. Relationships are complex and fluid. Therefore, most marital problems are multi-faceted and often related to deep-seated issues. Couples need to constantly discover new aspects about themselves, the other, and problematic situations in order to achieve mutuality and congruency.
Evaluation. Self-reflecting and reflecting on the process of change are necessary in order to evaluate progress. Fine tuning may be needed from time to time to ensure marital success
A Case Study: Meaning Therapy for Marital Problems
James was a 67-year old lawyer who still maintained a small legal office. His wife, Mary, was an in-house corporate lawyer working for a large insurance company. Their daughter was also a lawyer. They had a happy marriage without any crisis until Brad, a young, abrasive articling student, entered the picture at a critical point in the career of James and Mary.
James had just lost his two partners–his daughter and another young lawyer. Both of them had recently joined a large established law firm. In addition, he had also lost his receptionist/legal secretary due to maternity leave. Although James had considered retirement, he felt that his mission was not yet completed, and he still had several unfinished important legal cases. Brad seemed an answer to his prayer, because Brad was competent, fast, and able to take over the work of the legal secretary. In addition, Brad provided some legal insights on a couple of cases involving childhood sexual abuse and recovered memory, an area in which Brad had considerable knowledge, having done a MA thesis on this topic.
Because of the backlog due to the resignation of two junior partners and several impending court cases, James and Brad had to work overtime. There seemed to be a good chemistry between them, because both were Maverick, defiant, and had a strong instinct to defend the marginalized and fight for justice. James was delighted to have Brad at a time of extreme staff shortage; he even entertained the idea of keeping Brad as a junior partner.
Unbeknownst to James, while he was happily engaged in his legal work with his protégé, a huge storm was brewing. The intensity of the crisis shocked and overwhelmed him almost to the point of killing himself. The immediate trigger was Mary’s retirement. On several visits to James’s office, she saw James and Brad working so closely together that they were ignoring her presence; this sight was more than she could stomach. Her perception of alienation and rejection infuriated her, and she threatened to divorce James.
His Story: It Is a Tempest in a Tea Cup Created by Mary
According to James’s account, though he enjoyed working with his young protégé, he was not blind to Brad’s personality defects. Brad was very fast and efficient, but he tended to be sloppy. Growing up in a broken home and having to fend for himself since he was 15 years old, he had developed a defiant and arrogant persona as his first line of self-defense. Whenever Brad did not agree with something, he would try to stare people down with his sullen and defiant eyes, showing signs of passive aggression.
James was also aware of Brad’s ambition and egotistic tendencies. He also knew that Brad harbored a lot of resentment and hostility towards the rich and powerful, as evidenced in his sarcastic remarks. Brad was very competitive, often bragging about his victories and delighting in annoying those who were more successful than he was.
After working with Brad for half a year and winning a couple of significant cases with Brad’s legal research, he concluded that Brad was probably among the three best articling students he had ever had. The fact that Brad was in tune with his thinking and legal philosophy certainly made their working together pleasant and effective. Naturally, he often enthused about Brad’s work before Mary, without realizing that he had been adding fuel to Mary’s flame of anger. Because of James’s sense of fairness and his hard-nosed demand for evidence, the more Mary accused Brad without any supporting evidence, the more upset he became with Mary. His arguments with Mary in defense of Brad’s innocence only served to support Mary’s hypothesis that he valued Brad more than her and that he no longer cared about or loved her.
As a result of her constant complaints, James began to distance himself from Brad by limiting their conversation to work only. He also reassured Mary that he would let him go after completing his internship contract. To reduce the conflict, he also repeatedly reminded Brad to show his wife courtesy and respect. Being a smart survivor, Brad did not deliberately antagonize Mary, who was co-owner of the law firm. In fact, he tried hard to impress her by talking about his contributions to James’s cases. Unfortunately, Brad’s attempt backfired in a big way, because she took it as his attempt to send her the message that he was indispensable and smarter than she and that James valued him more than her.
James felt extremely frustrated because all her concrete complaints against Brad were either trumped up charges or exaggerated misattributions. She admitted that some of the stories were only trivial incidents that she brought up because she was very unhappy and trying to convince James that Brad was a dangerous man, who would destroy their business and their marriage. She was convinced that Brad had James completed hoodwinked, because of James’s vulnerability and need for companionship. James responded by saying that he was fully aware of Brad’s personality defects, but could not terminate Brad’s contract because he had exceeded all expectations for an articling student.
Mary exploded with anger when Brad bragged about having a publication with her husband. James explained to her that this publication was Brad’s MA thesis, which he was publishing with his university supervisor, and clarified that his own involvement with it was minimal. But nothing James said or did could placate her anger. James got so exasperated that he gave out primal screams to release his pain to the point of blacking out; a couple of times, he almost wanted to bang his head against the wall to end it all. He accused her of trying to kill him for no reason. She accused him of fighting with her in order to defend his favored assistant. She also accused him of having changed and no longer loving her; she even threatened to divorce him. He insisted that he had not changed and that it was she who had changed; it was she who no longer loved him, for if she did, she would not torment him every day and run the risk of causing him a heart attack.
To James, she had created a tempest in a tea cup because he could not figure out Mary’s catastrophic response to Brad’s presence. He said to Mary: “Nothing Brad has said or done calls for this kind of non-stop, hysterical and vicious attack on Brad and me. I think you are mentally ill and you really need professional help.” To which, she went ballistic and responded screaming: “I will never forgive you for calling me crazy. How could you insult me to protect a young punk.” He rebutted: “But it has nothing to do with Brad; it has everything to do with your unreasonable and catastrophic reactions. You treat me as if I have committed an affair.”
Her Story: James Had Created a Monster to Torment Her and Destroy Their Marriage
After a couple of years of working with James in their own law firm, Mary spent the rest of her legal career as an in-house lawyer in an insurance company. She enjoyed the security of working for a large institution as a valued professional. She got along well with the management and staff. She was well respected. By all accounts, she had had a successful legal career.
She became increasing irritable and anxious when her date of retirement approached. She was worried about what to do with herself after her retirement, because she was still healthy and active. James suggested that she rejoin him at the firm and gradually build up her legal practice, but she was not enthused about the idea. She wanted to take a break from legal work and just help out a little bit around the office.
Retirement hit her hard. She felt completely displaced, disoriented, and disenfranchised without an identity and without connections. Her sense of lostness gradually turned into frustration and hopelessness. This negative frame of mind worsened when she spent a few hours a day at the office without any well-defined meaningful work, while James and Brad were happily working together and going to court together.
She summarized the three things that made her very upset. Firstly, she felt completely shutout from the on-going work at the law firm. “I feel that I am only good at doing the work of a receptionist, buying groceries, and serving them lunch and snack. I have become their maid and secretary,” she complained. Secondly, James showed special kindness to Brad and became very impatient with her; this observation convinced her that James no longer cared about how she felt or even loved her because of Brad. She stated that one day she felt so devastated that she sat in the car crying uncontrollably, as if her life and marriage were destroyed by James and Brad.
She insisted that she did not have any psychological problem and that James and Brad created hell for her. From her perspective, James favored Brad so much that he had unwittingly turned Brad into a monster, who insulted her and tormented her every time she went to the office. She was convinced that the therapist would agree with her that James and Brad were responsible for all her pain and misery.
Assessment and Treatment of the Case
Similar to most marital conflicts, this couple presented drastically different perspectives of the same set of events. What made this case unique is that James and Mary had a strong and happy marriage, which was derailed by their seemingly irreconcilably different attitudes towards Brad. Their differences were related to how they reacted to existential issues. James was primarily concerned with generative and integrative issues, mentoring a protégé to carry on his legacy, whereas Mary was primarily concerned with her identity crisis and personal losses during retirement. James’s work did not suffer any disruption; he continued to do what he loved with someone he liked. But Mary was still in transition, feeling very insecure and uncertain about her future; her acute existential crisis was largely responsible for her unhappiness.
James’s Lack of Empathy and Understanding
During the course of meaning therapy, James realized he was also responsible for their marital problem because of a break down in communication. He had taken Mary for granted and assumed that she would manage her retirement well because she had always been a competent, independent professional woman. His main problem was his lack of awareness of and empathy for Mary’s existential crisis in a time of major life transition. He also failed to understand the intensity of her psychic pain. His dismissal of her desperate cry for help as a “tempest in a tea cup” was a clear sign of his lack of understanding her emotional needs. James readily confessed his failure to meet Mary’s emotional needs and took immediate steps to improve congruent communication.
James also became aware of his own vulnerability and his desperate need for leaving a legacy; this personal need made him overlook some of Brad’s defects and led him to prematurely embrace him as his standard-bearer. Another lesson he learned from therapy was that he needed to restore some balance in his life (Wong, 1998b, in press). Although it was noble of him to spend time fighting for justice for the disfranchised, mentoring his protégés, and contributing to the legal literature, he realized the need to spend more quality time with Mary and pay more attention to her need for physical and emotional intimacy.
Mary’s Existential Crisis and Misattribution
Mary was in a transition stage in her life and needed to address the existential and neurotic anxieties (May, 1950) triggered in her by retirement. Since she was an institutional person for almost all of her professional life, her self-identity, self-esteem, and personal meaning were largely based on her good performance for the corporation as the chief legal counsel. Meaning therapy helped her to discover a sense of authentic self so that she could live a more purposeful and fulfilling life without an institutional affiliation.
The therapist explained that her retirement created a real crisis mentality of loss and vulnerability. In this negative frame of mind, she genuinely felt that her world was falling apart and that she was losing everything of value to her. In other words, her existential anxiety triggered her neurotic anxiety about losing her husband to Brad–a fear that had no basis in reality. Her insistence on blaming him for her problem contributed further to their marital problem. Mary also needed help understanding what caused James’s intense reaction. It took many sessions before she realized that James had not changed, but that she had changed because of her very unsettling life transition.
The PURE Intervention
The PURE strategy was employed to reduce Mary’s anxiety and resolve her marital conflict. First, the therapist pointed out the paradox that her excessive and aggressive attempts to protect their marital relationship had had the exact opposite effect of driving him away. She also recognized the dilemma that, on the one hand, she really loved James and wanted him to be happy and healthy, and, on the other hand, she had caused him so much pain and suffering. A lot of time in therapy was devoted to helping her find a way to resolve the paradox and achieve her intended purpose of strengthening her marital relationship through congruent communication.
The therapist accepted her phenomenological account as very real to her, but also challenged her to understand the following chain of events: Existential crisis – distorted perception of events – faulty attribution about intention – trumped up charges and unrelenting attack – making James very angry with her irrational behavior – confirming her hypothesis that he no longer loves her – heightened anxiety and anger.
Once she understood this vicious cycle, she was willing to explore more positive frames of reference. For example, when she was challenged to imagine how she would react to the same sight of James and Brad working together if she had a prosperous legal practice and had her own competent assistants, she answered that from such a positive perspective, she would not be bothered at all.
The therapist further challenged her to see things from James’s perspective and empathize with his emotional needs. He challenged Mary to put aside her assumptions and emotions in order to have a dialogue with James regarding their differences about Brad. The therapist also pressed the point that Mary’s accusation of James treating her as garbage was totally inconsistent with her own account that he had always been a loving, long-suffering and self-sacrificial husband.
With this new understanding, she began to admit that working all alone in the law office, James did need Brad not only as an assistant but also as a friend. She also realized the urgency for James to work long hours to prepare for court hearings.
The responsibility component of couple therapy was to make her fully aware of the consequence of her behavior on herself and her husband. She needed to realize her daily fighting with James had taken a toll on both of them. She had almost destroyed his mental and physical health. Therefore, she needed to work towards repairing the damage and rebuilding the marital relationship. After considering the pain and agony she had put James through, she agreed to apologize for not trusting him and for attacking him unfairly. She also promised to grant him the same kind personal space he used to enjoy while she was working fulltime elsewhere.
The PURE intervention was facilitated by the ABCDE strategy. When Mary accepted her existential anxiety and her feelings of insecurity as normal, her neurotic anxiety of losing James to Brad was gone. She also learned to believe that there was plenty of life after retirement and that James still loved her. Once she was committed to building a new future for herself, she discovered that there were indeed many new opportunities for her to use her expertise and experience. She actually enjoyed developing her private practice in partnership with James.
By the time she had successfully reestablished her independent legal practice and was serving as a legal consultant and Board member for several non-profits, she was able to view the unhappy chapter in her life in a different light. One night she broke down weeping and apologized to James, because she was really convicted of the unnecessary injury she had inflicted on him for no other reason that her own insecurity and jealousy. Their marriage was now stronger and happier than before the incident of Brad. Meaning therapy had helped both of them gain a better understand of themselves, each other, and the problems that arise in their marriage. Their ability in congruent communication gave them the freedom and courage to resolve their marital conflicts and create a better future.
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