Psychotherapy and the Meaning of Life

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

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

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

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

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

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

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

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

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

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

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