From the perspective of existential therapy, communication with the other involves much more than therapeutic alliance and the mechanical act of transferring information from a sender to a receiver; in fact, it is not possible to talk about existential communication without understanding the nature of authentic relationship and the presence of the therapist.
The Presence of the Therapist
For humanistic-existential therapy, presence means more than being psychologically attentive to the interactions taking place every minute of the session; it also means the existential presence of the total being of the therapist. Presence matters because the messenger is an important part of the message. A message is credible to the extent that the messenger is perceived as credible. By the same token, therapy is effective to the extent that the therapist is perceived as competent and caring.
More specifically, the therapist needs to possess and project certain positive personal qualities. Rogers (1951) maintains that the curative effect of relationship can only be fully understood in terms of the personal qualities of the therapist: empathy, genuineness, and unconditional positive regard. Similarly, Deurzen (2009) emphasizes that good existential therapists must possess positive personal characteristics, such as emotional maturity, the capacity for self-reflection, and willingness to question the status quo.
An existential therapist is open, authentic, caring, and vulnerable in order to facilitate authentic encounters. According to Buber (1923/1970), presence matters because it is essential for establishing an I-Thou relationship. The presence of the therapist conveys love and caring for the other as a whole being. Communicating true caring in an existential encounter enables the other person to explore, change, and grow. Authentic encounters and genuine dialogue are possible only within an I-Thou relationship.
According to Deurzen and Adams (2011), human beings are relational; no one can exist separately from their relationships. The foundation of all relationships is the need to belong, to love, and to be appreciated and valued in return; the healthy relationship is characterized by mature interdependence and existential communication based on authenticity and mutuality (Deurzen, 2009).
Yalom (1980) focuses on the dynamic process of the here-and-now encounter. Each therapeutic encounter reveals the phenomenological experiences and 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 clients’ problems, the therapeutic relationship not only provides an antidote to loneliness, but also renews a sense of connectivity and belonging. This is of particular importance for relationship therapy, since this enables partners to reconnect to each other in a real way.
Similar to Buber’s concept of the I-Thou relationship, Jaspers emphasizes that we have to be willing, open, and vulnerable in order to be involved in an ever-deepening dialogue. There is a reciprocal connection between communication and relationship; a trusting and deep personal relationship facilitates existential communication, which further deepens the relationship. Karl Jaspers, more than Buber and other existential philosophers, has contributed most to our understanding of existential communication, which is possible only in a deep and authentic personal relationship (Jaspers, 1957, 1959, 1970).
According to Salamun’s (2006) analysis of Karl Jaspers ideas, a human being can realize the meaning of life in four modes of being, and each mode entails a different kind of relationship and communication. In the most basic biological mode of existence, communication is primarily dictated by physical needs, spontaneous emotion, and instinctive impulses, without self-reflection. In the second ‘consciousness’ dimension of self-realization, communication is characterized by logical thinking and rationality. In the third dimension of Being, Geist (spirit or reason), communication is guided by personal ideals, moral worldviews, and the capacity to see the different parts of a meaningful whole. Finally, in the Existenz (existential) mode of self-realization, communication is based on authentic and intimate interpersonal relationship, which enables one to discover and realize one’s meaning of life.
According to Spinelli (2007), existential-phenomenological therapy operates in the context of an interpretative world as well as a relational world. At the existential level, we move towards a deeper understanding of the truth of self and the other; at the same time, we also discover more about human existence and the meaning of life. Existential communication is liberating and empowers the communicator to search for truth and personal growth.
There is no single universally agreed upon approach to existential therapy. Meaning therapy (MT; Wong, 2010) represents a Canadian model that is integrative in its attempts to bridge the existential tradition and mainstream psychology and positive psychotherapy (Wong, 2009, 2011). However, MT still shares the same existential concerns and skill sets of other existential approaches, such as Frankl’s logotherapy and the American humanistic-existential tradition. In terms its origin, MT is an extension of logotherapy (Wong 2012a).
One of the key themes of existential therapy is its concern with the meaning and purpose of human existence and individual lives (Deurzen, 2009; Frankl, 1985). MT employs meaning as the central construct to integrate relevant skills from other schools of psychotherapy, such as cognitive behavioral therapy (Ellis, 2004) and narrative therapy (White, 2007). According to the motto of MT, “Meaning is all we need; relationship is all we have.” This motto holds true for both the client and the meaning-centered existential therapist.
Meaning is all we need, because all clinical problems are in some way related to a lack of proper understanding of self and personal problems, and the difficulty in finding a fulfilling life purpose. Relationship is all we have, because we can only work through authentic therapeutic relationship and genuine dialogue to facilitate healing and positive change. In couple counselling, we also empower clients to develop congruent communication as a way to resolve conflicts (Satir, Banmen, Gerber, & Gormori, 1991).
MT’s approach is primarily based on the PURE and ABCDE models (Wong, 2010)–the two major intervention strategies in MT. Being integrative, MT employs a wide variety of clinical skills which can be grouped into four conceptual frameworks or models: Frankl’s Meaning Seeking Model (Wong, in press), PURE, ABCDE, and the Dual Systems Model (Wong, 2012d). Each model contains testable hypotheses and can be a framework for both assessment and intervention.
MT includes a psychoeducational component, which entails teaching clients meaning-centered intervention skills that can help them cope with their problems and live more rewarding and fulfilling lives. In this chapter, we briefly describe how each component of PURE and ABCDE intervention strategies can guide the therapist to use appropriate clinical skills. We will present a case to illustrate how these two intervention strategies can be applied in dealing with existential and relational issues.
The PURE Framework & Intervention Strategy
Consistent with traditional existential themes and current research on meaning (Wong, 2012b), we define meaning in terms of PURE, which stands for Purpose, Understanding, Responsibility and Enjoyment. PURE provides not only a comprehensive definition of meaning, but also a conceptual framework for working with clients who seek to make sense of their lives and try to make responsible choices in the midst of chaos and uncertainty. In couple therapy, each component of PURE represents an essential building block in improving communication and developing a healthy relationship. Together, PURE is important for broadening clients’ horizon of interpretations so that their perceived meanings will be more congruent with their spouse’s perceptions and the actual problem.
Purpose refers to intentions, directions, and life goals. A major part of existential therapy is to help clients clarify their own assumptions, discover their true purpose of life, and empower them to strive for achievable life goals. Therefore, within the theoretical component of purpose are a number of clinical skills, such as vocational counselling, goal setting, and goal striving, which can be used by the therapist depending on the need of the client.
In meaning-centered couple therapy, the most important factor for a successful relationship is that the couple enjoys shared meaning and purpose (Deurzen, 2010; Gottman, 1998), while remaining true to their own individuality. It is difficult to plan life together when the individuals have conflicting life goals and priorities. Clients also need to bear in mind that the purpose of couple communication is not just to make their 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 involves making sense of self, others, situations, and life as a whole. Deurzen and Adams (2011) emphasize that self-understanding cannot be fully achieved without understanding others and the larger context of the human condition. Congruent communication involves making sense of self, others, and events in a way that promotes mature interdependence as well as personal growth. MT teaches clients that the personal meaning they attach to an event has greater impact on them than the event itself. 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.
As free agents, people are responsible for their reactions to what life and situation demand of them (Frankl, 1985). Responsibility also means making choices that are rational, realistic, and ethical (Deurzen, 2009). Clients are responsible for the consequences of their decisions and actions. To decrease conflict and negative emotions, couples are reminded that they are responsible for caring for each other’s wellbeing and understanding each other’s struggles in order to create a rewarding future together through congruent communication.
No relationship can survive for long if it is totally devoid of joy and positive reinforcement. The practice of Purpose, Understanding, and Responsibility in intimate relationships would naturally lead to higher satisfaction and fewer problems. However, couples also need to learn to intentionally express affection and create opportunities to have a good time together. Deurzen (2009) reminds existential therapists of the human potential for enjoying life: ‘Human freedom and ingenuity can enable people to live well and to the full’ (p. 173). MT empowers clients to look at the bright side of their relationship and remember the good times they have had together.
The ABCDE Framework & Intervention Strategy
This is another major meaning-centered model that is based on existential themes. 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. The ABCDE intervention 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.
People need to accept life as it is – the good, the bad, and the ugly, as well as accept the imperfections in themselves and others in order to reduce unnecessary anger and frustration (Wong, 2012c). Acceptance is one of the main themes in existential therapy. Acceptance of reality and each other is the first step towards reparation of broken relationships. Couples need to accept each other’s feelings and failings, and work towards congruent communication. If one party denies his or her culpability and completely blames the other, the conflict will escalate. Cultural barriers in mixed marriages increase the likelihood of conflict. Accepting cultural differences between East and West in expressing emotions (Hoffman & Cleare-Hoffman, 2011) can facilitate communication.
Belief in the intrinsic value of individual life and in the meaning potential in all situations gives people hope (Frankl, 1985). Tillich (1952/2000) also emphasized the vital role of faith and belief in a similarly meaningless world. Hope is essential for healing and growth. Couples need to believe that their marriage is worth saving and their problems are solvable in order to achieve a successful outcome in marital therapy. If one party is already dead-set on divorce, it is very unlikely that the marriage can be saved.
Commitment is another existential theme. It is sometimes conceptualized as a leap of faith (Kierkegaard, 1844/1980) or the courage to create in the face of uncertainty (May, 1975/1994). In essence, commitment refers to a determination to pursue a life goal or a task in the absence of sufficient information and assurance of success. In meaning-centered relational therapy, it takes time and effort to rebuild trust and repair broken relationships. Couples therapy will work only when both partners are committed to making the necessary changes to save a relationship 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).
Human beings are complex and constantly evolving. Relationships are complex and fluid. Therefore, most relationship 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.
Self-reflecting and assessing the effectiveness of adjustment are necessary in order to improve relationship. Fine-tuning is needed from time to time to ensure that the elements of ABCD are working well.
Meaning-Centered Relational Therapy
A meaning-centered approach to relational therapy is based on MT, which assumes that we are relational creatures with the basic need for belonging and attachment (Bowlby, 1988; Bugental, 1956; Deurzen, 2009; 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 mature interdependent relationships. Good and open communication is an essential clinical tool to bring clarity and resolution to personal predicaments. However, MT elevates communication to the level of existential communication. A great deal of therapy time is spent on making explicit the implicit meanings and hidden needs that contribute to interpersonal conflict.
Given the emotion-laden quality of couples’ communication, especially in unpleasant and stressful situations, MT emphasises the importance of self-distancing and viewing each problem within a larger context of individual struggles with existential givens. Self-detachment provides some space between the person and the problem and allows clients to normalize their predicaments in light of existential universals.
Extending Frankl’s logotherapy to couples, Lantz (1996, 1998) emphasizes the importance of making use of the meaning potentials in intimate relationships. Couples need to understand the demand characteristic of each relational problem and choose to do the responsible thing. 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.
To reduce miscommunication, MT emphasizes active listening. In fact, MT teaches clients five levels of listening through modeling. 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 engage in congruent communication and develop new ways to relate to each other.
The following case study demonstrates how MT is applied to a couple facing a marital crisis. During the intake session, the therapist explained that MT emphasizes meaning and relationship and requires them to learn some evidence-based practical skills to relate to their problems and engage life in a healthy and productive manner. During the termination session, the therapist summarized how the PURE and ABCDE had been effectively applied to their marital crisis.
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. They had a happy marriage without any crises until Brad, a young, and abrasive articling student, entered the picture at a critical point in the careers of James and Mary.
James had just lost his junior partner and 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. He was delighted when Brad started helping him, because he was competent, fast, and able to take over the work of the legal secretary. In addition, Brad also had legal insights.
Because of the backlog and several impending court cases, James and Brad had to work overtime. As a result, James overlooked the needs of his wife and unknowingly contributed to a marriage crisis. James was totally surprised by the intensity of the crisis. The immediate trigger of Mary’s unhappiness was her retirement.
On several visits to James’s office, James and Brad were so engrossed in working together that they ignored her presence. Her perception of alienation and rejection infuriated her and she accused James of caring for Brad more than her. James responded with anger to her accusation because it had no factual basis. When the marital conflict escalated to an unbearable level, Mary threatened to divorce James. At this point, they both agreed to seek professional help.
During the therapy, there were many tense moments because, to James, the crisis was a storm in a tea cup created by her distorted perception of his relationship with Brad. But according to Mary, it was a huge painful experience to see her husband hoodwinked by a young punk who despised her.
Because of James’s sense of fairness and his hard-nosed demand for evidence, he became upset with Mary when she accused Brad of intentionally insulting her without any supporting evidence. His arguments 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. To prove his sincerity, James reassured Mary that he would let him go after completing his internship contract, even though originally he was thinking of hiring him. To reduce the conflict, he also repeatedly reminded Brad to show his wife courtesy and respect. Unfortunately, Brad’s attempt to please Mary and impress her with his contribution to the firm backfired in a big way, because she took it as his attempt to send her the message that he was indispensable and that James valued him more than her.
In the course of therapy, Mary admitted that some of the stories against Brad were made up in order to convince James that Brad was a dangerous man who would destroy their law firm and their marriage. She complained about being victimized by James and Brad and she wanted to rescue James from Brad. When her irrational belief was challenged, she insisted that her perception was true, because her pain was true. It took a great deal of time to convince her that distorted perceptions can also cause real pain and to help her realize that her distorted view was largely due to her own existential crisis.
After a couple of years of working with James in their own law firm, Mary had 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. Retirement hit her hard. She felt completely displaced, disoriented, and disenfranchised without an identity and without connections. Her sense of being lost gradually turned into frustration and hopelessness. This negative frame of mind worsened when she started spending a few hours a day at the office without any well-defined meaningful work, while James and Brad happily worked and went to court together.
James could not understand Mary’s catastrophic response to Brad’s presence. He was so exasperated by her irrational behavior, that he said to her: ‘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’. In reaction to this, she went ballistic and responded by 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.”
Assessment & Treatment of the Case
Similar to most relationship conflicts, this couple presented drastically different perspectives of the same set of events. What made this case interesting was that James and Mary had 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 and the marital crisis.
James’s Lack of Empathy & Understanding
During the course of meaning therapy, James realized he shared responsibility for their marital problem because of a breakdown in communication and trust. He had taken Mary for granted and assumed that she would manage her retirement well. 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 ‘storm in a tea cup’ was a clear sign that he didn’t understand her emotional needs. James readily confessed his failure to meet Mary’s emotional needs and took immediate steps to improve congruent communication.
In reflecting on his phenomenological experiences, James also became aware of his own vulnerability and his desperate need to leave a legacy; this personal need made him overlook some of Brad’s character 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. 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 realised the need to spend more quality time with Mary and pay more attention to her need for physical and emotional intimacy. During the time that they worked apart, operating in two different worlds, they had already drifted apart imperceptibly.
Mary’s Existential Crisis
Mary was in a transition stage in her life and needed to address her existential and neurotic anxieties (May, 1950). 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. MT helped her to shift from performance-based self-assessment to a new understanding of authentic being. She needed to discover her own path and live a purposeful and fulfilling life without an institutional affiliation.
It took many sessions before she realized that James had not changed, but that she had changed because of her very unsettling life transition. Self reflection and perspective taking enabled her to realize that blaming James and Brad for her existential crisis was the main cause of their marital crisis. When she was able to distance herself from her emotional pain, Mary was able to understand what had caused James’s strong words and anger and see that this reaction was typical for him in response to false accusations.
The PURE Intervention Strategy
The PURE intervention was effective in resolving their marital problem. 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 finally 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.
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, caring and self-sacrificial husband.
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 take personal responsibility to work towards repairing the damage and rebuilding the marital relationship She agreed to apologise for not trusting him and for attacking him unfairly. She also promised to grant him the same kind of personal space he used to enjoy while she was working fulltime elsewhere. For his part, James also apologized for not spending enough time with her and for not understanding her existential crisis. He felt happy that she finally admitted that she had accused him unfairly.
The PURE intervention strategy was facilitated by the ABCDE strategy. When Mary accepted her existential anxiety was normal for people during life transition, her neurotic anxiety about 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. In her self-reflection and evaluation, she was satisfied that she had successfully resolved her dilemma.
In addition to helping Mary develop a deeper understanding of herself and her marital crisis, the therapist also emphasized the importance of mutual interdependence that allows both mutuality and individuality. When Mary played the roles of victim, accuser, and rescuer, she not only failed to take responsibility for her happiness, but also robbed James of his freedom and personal space. She learned that a better way to express her needs was through frequent communication and open dialogue without accusation and anger.
Both James and Mary learned the PURE and ABCDE interventions so that they could continue to use these skills to improve their communication, coping skills and enhance their well-being. In this case, the therapy has been effective. One year after the therapy, Mary had successfully reestablished her independent legal practice and was serving as a legal consultant and board member for several non-profit organisations. She was able to view this unhappy chapter in her life in a different light. According to Mary’s followup feedback, one night she broke down weeping and apologizing to James, because she was really convicted of the unnecessary injury she had inflicted on him for no other reason than her own insecurity and jealousy. Their marriage was now stronger and happier than before the episode with Brad. Meaning therapy had helped both of them gain a better understanding of themselves, each other, and their marital crisis Their new ability in congruent communication gave them the freedom and courage to resolve their marital conflicts and create a better future.
In a time of managed-care’s emphasis on evidence-based practical skills, MT is able to provide empirical research as the basis for many of its intervention skills. By taking an integrative stand, MT was flexible enough to employ relevant skills from CBT, narrative therapy, and positive psychotherapy to address problems related to both existential and cognitive meaning. Its psychoeducational approach to equipping clients with the necessary skills, MT makes it easier to transition from therapy to everyday living. With these characteristics, MT may represent one of the ways to move existential therapy forward in a therapeutic world dominated by manualized evidence-based therapies.
The case presented here illustrates how MT can be applied to relational therapy. It also demonstrates the importance of (1) addressing underlying existential issues, and (2) removing barriers of communication due to distorted perceptions and misattribution. Specifically, we show that PURE and ABCDE strategies can be effectively employed to achieve these two therapeutic objectives in the context of marital conflicts.
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Published as Wong, P. T. P., & Wong, L. C. J. (2013). The challenge of communication: A meaning-centered perspective. In E. van Deurzen, & S. Iacovou (Eds.), Existential perspectives on relationship therapy. Hampshire, UK: Palgrave Macmillan.