Journal of Constructivist Psychology

ISSN: 1072-0537 (Print) 1521-0650 (Online) Journal homepage: http://www.tandfonline.com/loi/upcy20

Five Perspectives on the Meaning of Meaning in

the Context of Clinical Practices

Joel Vos, Mick Cooper, Clara E. Hill, Robert A. Neimeyer, Kirk Schneider &
Paul T. Wong

To cite this article: Joel Vos, Mick Cooper, Clara E. Hill, Robert A. Neimeyer, Kirk Schneider
& Paul T. Wong (2017): Five Perspectives on the Meaning of Meaning in the Context of Clinical
Practices, Journal of Constructivist Psychology, DOI: 10.1080/10720537.2017.1390511

To link to this article: https://doi.org/10.1080/10720537.2017.1390511

Published online: 11 Dec 2017.

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 JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY, 0(0), 1–15, 2017
Copyright 
C Taylor & Francis Group, LLC
ISSN: 1072-0537 print / 1521-0650 online
DOI: 10.1080/10720537.2017.1390511

Five Perspectives on the Meaning of Meaning in the

Context of Clinical Practices

Joel Vos
Mick Cooper
Department of Psychology, University of Roehampton, London, UK
Downloaded by [94.133.196.31] at 00:20 22 December 2017

Clara E. Hill
Department of Psychology, University of Maryland, College Park, Maryland, USA

Robert A. Neimeyer
Department of Psychology, University of Memphis, Memphis, Tennessee, USA

Kirk Schneider
College of Psychology and Humanistic Studies, Saybrook University, Oakland, California, USA,
and Teachers College, Columbia University, New York, New York, USA

Paul T. Wong
Department of Psychology, Trent University, Ontario, Canada, Trinity Western University,
British Columbia, Canada, and Saybrook University, Oakland, California, USA

What is meaningful in life? This is a question many individuals ask at least once in their lifetime.
Many researchers have also asked this question, and a large body of literature seems to answer in
theoretical and academic terms. But what is the meaning of meaning in clinical practice? That is,
what is the role of meaning in psychotherapy, recovery, and positive mental health? And how could
meaning in life be addressed in practices: What clinical competencies are needed? To answer these
and other questions, a broad panel of researchers and practitioners met at the world conference of
the International Network for Personal Meaning (INPM) in Toronto in July of 2016. A passionate
debate followed, particularly on the question of the meaning of meaning in clinical practice. In this
article, five panel members—Mick Cooper, Clara Hill, Robert Neimeyer, Kirk Schneider, and Paul
Wong—elaborate their perspective on these two questions. At the end of the article, the moderator,
Joel Vos summarizes, their differences and agreements, and suggests a pluralistic, multidimen-
sional perspective on meaning for practitioners. Despite some fundamental differences, the authors
report many similar perspectives on the meaning of meaning in clinical practice and on clinical

Received 19 September 2017; accepted 20 September 2017.

Address correspondence to Dr. Joel Vos, Department of Psychology, University of Roehampton, Holybourne Avenue,
SW15 4JD, Roehampton, London, United Kingdom. E-mail: psychvos@yahoo.com
 2 J. VOS ET AL.

competencies. This debate could be used as an example of how practitioners could also converse
with their clients; the process of exploring the question, “What does meaning mean to you here and
now, in our therapy room?” could be meaningful in itself.

INTRODUCTION

There is possibly nothing as unique as meaning. What one person experiences as meaningful may
lack meaning for another. Individuals may differ in the process of how they develop their unique
sense of meaning. How practitioners can help clients can also be different for different individuals
in different situations (see Vos, 2014, 2016). Despite this uniqueness, many researchers have
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tried to identify common themes among individuals, and a large body of literature discusses what
meaning in life is in theoretical and academic terms (e.g., Battyanyi & Russo-Netzer, 2014; Wong,
2012).
Similarly, different meaning-centered researchers and practitioners have different perspectives
on the meaning of meaning in psychotherapy, recovery, and positive mental health. They also of-
fer a wide-ranging array of clinical competencies. For example, systematic literature reviews have
identified more than 30 different schools of meaning-centered practices, and more than 39 unique
clinical competencies emphasized by one or more of these schools (Vos, 2016). This wide diver-
sity has been explained as the consequence of the unique nature of meaning, and the “gurufication”
and rejection of standardization in the field of meaning (Vos, 2016).
Researchers and practitioners showed a similar pluralism during a panel discussion at the world
conference of the International Network for Personal Meaning (INPM) in Toronto in July 2016.
A passionate debate followed, particularly on the question of the meaning of meaning in clinical
practice. In this article, five panel members elaborate their perspective on two questions: (a) What
role does meaning have in clinical practice? (b) Which clinical competencies are required? At the
end of the article, the moderator, Joel Vos, summarizes their differences and agreements, and
suggests a pluralistic, multidimensional perspective on meaning for practitioners.

CONTRIBUTIONS

Mick Cooper: A Pluralistic Perspective on the Meaning of Meaning

What is the meaning of meaning in the context of clinical practice, and how should therapists
work with it? From a “pluralistic” therapeutic standpoint (Cooper & Dryden, 2016; Cooper &
McLeod, 2011), meaning may have a multiplicity of meanings in therapy, and may be effectively
addressed in a variety of ways.
A first point of diversity may be the significance of meaning to individual clients. For some
clients, as the research shows, issues of meaning may be of paramount importance (Vos, 2016).
However, for others, it may only be a subsidiary concern, or not be salient at all. We can also
differentiate between the significance of this issue at the explicit level and at the implicit level.
For instance, as proposed by Frankl (1986), a client may come to therapy with alcohol addiction,
only later to find that the underlying issue is a profound sense of existential vacuum. On the
other hand, a client who is explicitly concerned about meaninglessness in his or her life may
 FIVE PERSPECTIVES ON THE MEANING OF MEANING 3

subsequently find that his or her real fear is of death or isolation (Yalom, 1980). Closely related
to this, there may be differences between clients who have a need to find meaning and purpose
in their lives and those who need to come to terms with a sense of meaninglessness. We can
also distinguish concerns about meaning from concern about purpose—the latter having a more
future-oriented and motivational component. A client with the former concerns may be asking,
“What is the meaning and significance of my life? Why am I here? What is the reason for it?”
By contrast, a client with the latter concerns may be asking, “What do I want to achieve in my
lifetime? What are my medium- and long-term goals??
Addressing each of these meanings of meaning may require a different—albeit overlapping—
set of clinical competences. However, given the potential for issues of meaning to be implicit as
well as explicit, it is probably important that therapists of all orientations have some basic skills
in working with issues of meaning and purposes. With respect to the former, perhaps the most
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basic skill is the ability to recognize when clients have underlying concerns about the meaning of
their lives, and the capacity to respect this as an issue in its own right. This means being able to
engage with this concern in a respectful way, rather than pathologizing it or reducing it to some
other theoretical construct, such as irrational thinking or transference. Here, an important meta-
competence may be the ability to acknowledge and validate clients’ feelings of meaninglessness
while, at the same time, helping clients to explore and discover new meanings.
With respect to issues of purpose, a useful contextual competence may be the ability to help
clients set and work toward goals in therapy. Although not all clients find this helpful, our research
suggests that many do find it a valuable process (Cooper et al., 2015). Helping clients to think
about their life goals, more broadly, may also be a valuable competence, along with the capacity to
attune to, and reflect back, the future-oriented elements of a client’s narrative (Bohart, 2001). Hav-
ing the skills to then help clients work toward their goals, developing plans and “implementation
intentions” (Gollwitzer, 1999), may also be a valuable competence. This may draw on knowl-
edges and practices from a variety of orientations. For instance, psychodynamic strategies, such
as developing insights, may help clients identify their blocks to achieving their goals; whereas
behavioral strategies, such as role plays, may help them rehearse methods for overcoming them.
From a pluralistic standpoint, however, perhaps the most important meta-competence is the
ability to work collaboratively with clients to help them identify the ways of working—or not
working—with meaning that are most suited to their individual wants and needs.

Clara Hill: An Integrated Approach to Working with Meaning in Life in

Psychotherapy

Meaning in life (MIL), which I have defined as “a global intuitive sense of meaning, which may
be partially manifested in a felt sense of meaning, the feeling that one matters and is significant,
one has purpose or goals, and one’s life is coherent or makes sense” (Hill, 2016), seems to be an
important component of wellbeing and identity. For example, research has shown that people who
rate themselves as having low MIL are depressed and neurotic, whereas people who rate them-
selves as having high MIL have high life satisfaction, positive emotions, and wellbeing (Steger,
Frazier, Oishi, & Kaler, 2006).
Given this definition and these data, it makes sense that, although it may not always be an
explicit focus, MIL is at the heart of all psychotherapy. We try to help clients make sense out of
 4 J. VOS ET AL.

their lives, feel that they matter, have a more coherent narrative, and sometimes work on their
goals and purposes.
My approach to working with MIL in psychotherapy is based on the foundation of therapist
self-awareness (therapists need to have reflected about their own MIL to feel comfortable helping
clients reflect about MIL), conceptualization (so that therapists have an understanding of how MIL
figures into client dynamics), and a good therapeutic relationship (so that therapists provide a safe
place for client disclosure). Then, once an MIL concern is identified, I suggest a flexible, three-
stage model of exploration, insight, and action. First, the therapist helps the client explore MIL
concerns, focusing on related thoughts and feelings. The therapist then facilitates the discovery of
insight so that the client gains a new understanding and sense of coherence. Finally, the therapist
works with the client to determine new and more appropriate actions to gain MIL.
I have found three highly rated interventions suggested by experienced therapists for working
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with MIL (Hill, 2016). These include offering support; helping clients examine thoughts, feelings,
and behaviors to discover hopes and goals; and facilitating exploration. Insight and action skills
varied more across clients. These results provide support for the importance of the exploration
stage before moving to other stages.
In addition, MIL work varies across presenting problems, stressing the need for therapists to
be responsive to individual clients. Although a few clients explicitly state MIL as a concern, our
research (Hill, 2016) suggests that clients more often talk about other concerns that have MIL
as an underling component. Hence, physical health, career, interpersonal problems, transitions,
trauma, deaths, and depression all can be explored for concerns related to MIL, with different
interventions recommended for each concern (see Hill, 2016).
I suggest that therapists reflect about their own MIL concerns to be humble and prepared for
working with clients about MIL; listen attentively for hints of MIL concerns with their clients;
allow clients to explore these concerns in a safe, trusting setting; and facilitate clients in gaining
insight and deliberating about action in relation to these MIL concerns. Encouraging clients to
engage in specific exercises related to MIL could also be helpful for raising awareness. See Hill
(2016) for more details about this approach and related research findings.

Robert A. Neimeyer: Intervening in Meaning

Viewed through a narrative constructivist lens, psychotherapy is a process of intervening in mean-

ing. As inveterate meaning makers, human beings punctuate the continual process of living by
discerning recurrent themes in experience, and use these to orient to the patterns and consistencies
of the natural and social worlds (Kelly, 1955). Mostly, this inherent and inescapable organization
of living proceeds at the levels of tacit knowledge, skilled performance, spontaneous interaction,
and communal ritual, which rarely require conscious reflection and mediation (Polanyi, 1958).
However, when the anticipation of this implicit order and sense making is invalidated, and the
narrative coherence of people’s life stories is profoundly disrupted—as through personal failure,
relational betrayal, or profound loss—they are commonly cast into a search for meaning to ac-
commodate what has transpired, and to reconstruct what to make of their lives in its aftermath.
Psychotherapy as a profession stands ready to partner in this effort.
One specific illustration of this process arises in the context of bereavement, the loss of a
significant attachment figure through death. With the substantial disruption of their previous
 FIVE PERSPECTIVES ON THE MEANING OF MEANING 5

self-narratives this entails, mourners commonly strive to reaffirm or reconstruct a world of

meaning that is challenged by the loss (Neimeyer, 2006), and they do so not only in the intimate
recesses of their private thoughts and feelings but also in a social world populated by others,
some of whom are mourning the same death. Accordingly, grieving can be viewed as a situated,
interpretive, and communicative activity, and not merely an intrapsychic state (Neimeyer, Klass,
& Dennis, 2014). By “situated,” we mean to emphasize that mourning is a function of a given so-
cial, historical, and cultural context; by “interpretive,” we draw attention to the meaning-making
processes it entails; by “communicative,” we stress the essential embeddedness of such processes
in written, spoken, and nonverbally performed exchanges with others; and by “activity,” we
underscore that grieving and mourning are active verbs, not merely states to be endured. Thus,
“grief work,” in this view, involves a pursuit of new comprehensibility and significance in a life
made strange by loss. This unfolds both at the level of trying to process or make sense of the
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“event story” of the death itself and its implications for our ongoing lives, and at the level of at-
tempting to access and reconstruct a connection to the “back story” of our life with the deceased,
to restore a modicum of narrative consistency and attachment security (Neimeyer & Thompson,
2014). A great deal of quantitative and qualitative research over the last 10 years has lent support
to this meaning-making model, as an anguished search for meaning consistently has been linked
to complicated and prolonged courses of grieving, whereas a capacity to make sense of the loss
and perhaps even find benefit or life lessons in it has been linked to more adaptive outcomes,
including longer term positive emotional states and posttraumatic growth (Neimeyer, 2016).
What clinical competencies are needed to facilitate this more favorable outcome in the context
of meaning-oriented psychotherapy? These can be summarized by the triad of presence, process,
and procedure (Neimeyer, 2009). At a foundational level, as with other existential and human-
istic psychotherapies, therapist presence in the form of authentic personal engagement with the
client, in a way that is undistracted by issues of “case conceptualization” or “treatment plans,”
provides the essential container or “holding environment” for the work. Beyond this, attunement
to the process of therapy, in the form of nuanced attention to the client’s emotional need and
readiness to take a further step in self-exploration or change, provides the orientation required in
each conversational turn to contact, symbolize, articulate, and renegotiate the emergent meanings
that will suggest new actions. Finally, the collaborative and often improvisational use of specific
procedures to explore significant emotion schemas or to enact inner, imaginal, or interpersonal
dialogues with self and others, allows the therapist and client to spark “innovative moments”
in and between sessions that conjure into being new possibilities beyond the constraints of the
problem-saturated narrative. Hundreds of such procedures of a meaning-oriented kind have been
identified, described, and increasingly researched in the context of grief therapy (Neimeyer, 2012,
2016). In sum, therapy can be understood as a process of intervening in meaning, a special class of
social construction in which clients and therapists courageously explore and reconstruct a world
of meaning that has become stagnant, stressed, or shattered by life events, opening it to a fresh
reading.

Paul Wong: Working with Meaning in Meaning Therapy

Because human beings are meaning-seeking and meaning-making creatures, meaning is

indispensable to psychotherapy. Beyond the fundamental linguistic meaning of clear commu-
 6 J. VOS ET AL.

nication between therapist and client, the following types of meaning are important areas for
psychotherapy:

1. Cognitive meaning—interpreting situations/people.

2. Narrative meaning—stories about one’s life/events, reminiscence, life review.
3. Unconscious meaning—repressed desires/memories, dreams, projections.
4. Cultural meaning—ethnic/cultural background/upbringing, cultural norms/values.
5. Motivational meaning—understanding motives, values, desires, wants, intentions, aspi-
rations, future direction.
6. Existential meaning—covering all existential questions regarding meaning of life, suf-
fering, death, self-knowledge.
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Meaning therapy (MT) addresses all the above types of meaning because the construct of
meaning is inherently holistic. Although meaning in life (MIL) issues primarily involve motiva-
tional and existential meaning, other types of meaning do have an indirect impact on one’s sense
of meaning, purpose, and significance.
MT assumes that psychological difficulties are more likely to occur when one’s basic need
for meaning, purpose, and significance (at work, in relationships, or in life overall) is missing.
Recovery and positive mental health depend on equipping clients with the knowledge and skills
to pursue meaningful life goals and cope with life’s demands.
MT is a pluralistic approach (Cooper et al., 2015) with meaning as the central integrative
construct in the climate of a trusting relationship. Clients are free to choose their preferred ther-
apeutic modality and are informed that interventions will be tailored to their needs, and some
psycho-educational elements will be introduced regarding the vital role of meaning and purpose
in healing and wellbeing.
Unique to MT and logotherapy is the assumption that life is inherently meaningful and mean-
ing can be discovered in every situation, no matter how bad. Frankl (1985) made a compelling
case that such affirmation is adaptive in surviving trauma and suffering. Braaten and Huta (2016)
have demonstrated empirically the adaptive benefit of such worldviews.
MT operates from the conceptual framework of PURE (Wong, 2012), which is an acronym
for (a) purpose (motivational dimension)—values, life direction, intentions, needs, wants, and de-
sires; (b) understanding (cognitive dimension)—coherence, comprehension, and sense making;
(c) responsibility (behavioral dimension)—self-determination, commitment, and action; and (d)
enjoyment (emotional dimension)—satisfaction and a sense of significance. Purpose, responsi-
bility, and enjoyment have been widely accepted as the components of MIL in meaning research
(Martela & Steger, 2016). Understanding is implied in research on self-determination and internal
locus of control. Consistent with existential therapy, MT emphasizes the responsibility to choose
one’s preferred future and authentic self.
Clinical competences in addressing MIL issues include these:

1. Explore the meaning dimension and cultivate a meaning mindset: This helps clients gain
new insight on life’s predicaments and reorients clients to the adaptive benefits of eudai-
monia and self-transcendence.
2. Use the ABCDE framework for coping with adversities (Wong & Wong, 2012): (a) Ac-
cept and confront reality—the reality principle; (b) believe that life is worth living—the
 FIVE PERSPECTIVES ON THE MEANING OF MEANING 7

faith principle; (c) commit to goals and actions—the action principle; (d) discover the
meaning and significance of self and situations—the aha! principle; and (e) evaluate the
above—the self-regulation principle.
3. Discover and cultivate sources of meaning (Wong, 1998): achievement, acceptance, tran-
scendence, intimacy, relationship, religion, fairness, and positive emotions.
4. Practice skills in meaning-focused coping (Folkman & Moskowitz, 2004; Wong, 2016):
(a) Adopt a defiant attitude toward adversity (courage); (b) reframe problems into a larger
context of meaning (self-transcendence); (c) reframe problems as challenges (reap-
praisal); (d) seek benefits in suffering (existential coping); (e) let go what cannot be
changed (existential coping); (f) reauthor and connect one’s life story to a meta-narrative;
and (g) encourage goal striving of something bigger than oneself.
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Kirk Schneider: The Sense of Awe

The core issue concerning the meaning of life in my view is not so much a concept, a thing, or
even a person but the sense of awe, that is humility and wonder or sense of adventure that informs
the background of all that we love. To the degree we can experience this sense of awe, discovery,
whole-bodied openness to the mystery of simply being, to that extent we can experience any and
all in our life as meaningful.
This holds even if we see life in strictly materialist terms as a random event that just happened to
produce a habitable planet, plants, animals, and human consciousness—even if all is some crazy
cosmic accident, it is still incredible and awe-inspiring. This is the part that too many secular
people miss in my view.
When we genuinely open to the tremendous mystery of being—that is, with our whole-body
experience and the capacity to be deeply moved—I do not see how we can get around how awe-
some it all is, and hence infinitely meaningful. One does not have to believe in a traditional religion
or ideology to see and feel this. One simply (and not so simply!) needs to cultivate a profound
presence to life, which encompasses our deepest dreads as well as our most dazzling desires—the
whole astonishing banquet.
And when we can tune in on that level, we can recognize a much bigger picture than the op-
pressive judgments/identifications to which most of us fall prey. We are those also, to be sure,
but we are perpetually more, and that is the crux, the dynamic tension of an awe-filled, meaning-
ful path. Just ask Stephen Hawking, Albert Einstein, or Viktor Frankl—or, better yet, read their
testimonies and see if you can live their wisdom (Schneider, 2008, 2009, 2013, 2017).

JOEL VOS: DISCUSSION

Unity

The reality of meaning-centered practices may be compared with a multifaceted diamond, which
needs lights to be cast from many different angles to see as many facets as possible (Vos, 2014).
Similarly, all five authors seem to subscribe the importance and uniqueness of meaning for in-
dividuals and the clinical work with them. Meaning is a subjectively lived, contextualized, and
awesome experience, which can only be accessed with an open attitude from both clients and
 8 J. VOS ET AL.

practitioners. It is also an experience that requires authentic commitment and translation into
daily life activities.
Practitioners need to attune to the unique meanings and processes of their clients, and they are
only able to do so via a positive practitioner–client relationship; their relationship is like a prism
through which light is cast on the experience of meaning. Meaning-centered practitioners also do
not seem to have the monopoly on helping clients to develop a meaning mindset. On the contrary,
the authors advocate a pluralistic approach: Meaning seems to be a common factor to all effective
therapies, although not all practitioners and clients can, must, or want to explicate the topic of
meaning in every situation (Vos, 2016, 2017a).

Diversity
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As unique as the experience of meaning are the different ways how the authors work with clients.
To understand their differences and overlaps, I conducted content analyses of the texts and contri-
butions to the panel discussion, using the six-step method of thematic analyses (Braun & Clarke,
2006). This revealed three dimensions: The authors differed in regard to their theoretical foun-
dations, their perspectives on the nature of meaning, and clinical competencies. Details of these
dimensions of differences can be found in the Appendix. These dimensions seem in line with other
systematic literature reviews on the meaning of meaning in therapy and counseling (Vos, 2016).
First, different authors seem to have different theoretical foundations. For example, some au-
thors explicitly used a pluralistic framework (e.g., Cooper, Wong). Some focused on being (e.g.,
Schneider), whereas others relatively more on doing and reflecting (e.g., Cooper, Wong). Wong
explicitly described how meaning is given, whereas Neimeyer proposed a constructivist approach
to meaning making as a dynamic process. Cooper focused on goals and purposes, and although
others such as Hill and Wong also mentioned these to be important, they also explicitly acknowl-
edged that meaning can be more than that, including Schneider, who promoted the generic sense of
awe and presence. All authors agreed on a nonreductionist perspective on meaning, which implied
acknowledging meaning in its own right without pathologizing or conceptualizing. Most authors
focused on the future orientation (“Where am I going?”), although Breitbart (as a panelist) also ex-
plicitly mentioned the importance of finding meaning in one’s life history, and the legacy one lives
here and now (Breitbart & Poppito, 2014). Although Wong described a wide range of emotions,
he seemed particularly interested in positive emotions, whereas Schneider and Neimeyer started
more explicitly with the full flow of experiences, including both positive and challenging emo-
tions. Furthermore, Wong described how individuals are always able to transcend themselves and
their situation, and can intuit the absolute difference between what is meaningful and what is not.
Second, the authors cast different perspectives on the nature of meaning. For example, Cooper
and Neimeyer focused on the meaning of specific events and specific experience (“microscale”),
whereas Wong and Schneider focused more on a global sense of meaningfulness. Cooper wrote
how meaning can sometimes be relevant, albeit as an underlying hidden cause of other manifest
problems, a position that others, such as Hill, whole-heartedly embraced. Whereas Schneider
seemed to suggest that meaning is primarily experienced as an intuitive receptive process, Cooper,
Wong, and Neimeyer focused more on the active creation of meaning. Most authors acknowledged
that both explicit reflections and implicit experience/action play a crucial role for individuals,
although different authors seemed to put more accent on the affective dimension (e.g., Schneider),
 FIVE PERSPECTIVES ON THE MEANING OF MEANING 9

behavior (e.g., Cooper), context (e.g., Neimeyer), and the significance of the self (e.g., Wong).
Wong described how individuals could find meaning via specific sources of meaning, whereas
others seemed to describe meaning as a dynamic process with unlimited sources. Some authors
elaborated the importance of experiencing meaning in the context of accepting meaningless and
loss (e.g., Neimeyer, Wong).
Third, different clinical competencies were mentioned. Almost all authors explicitly men-
tioned the importance of person-centered skills in being responsive to the client’s unique
subjective process. Some authors were more explicitly pluralist and nonreductionist than others,
and address the topic of meaning more explicitly with their clients. Wong and Breitbart helped
clients explicitly to focus on something bigger than themselves and their situation, whereas
others focused more on accepting the here and now or on specific goals. Neimeyer added the
importance of validating the experience of loss and meaningfulness, and of supporting clients
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to find meaning despite life’s challenges. Most authors recommended exploring a wide range of
meanings, whereas some—such as Cooper and Wong—also suggested focusing on setting and
working toward specific goals. Additionally, Cooper and Wong recommended developing the
client’s self, via self-insight, identifying blocks, and developing a sense of personal significance.
Most authors, including Cooper and Hill, explicated the importance of cultivating a supportive
and safe practitioner–client relationship. Authors also differed in their focus on creating coherent
narratives (Neimeyer, Wong), using specific procedures and techniques (Hill), explicit didactics
(Breitbart, Wong), positive emotions (Wong), accepting reality as it is (Neimeyer, Wong), and
restoring faith in life as worth living and the significance of the self (Wong).
These dimensions and examples are only identified for didactic purposes, and the conceptual
positions and practices of the authors are undoubtedly more nuanced. These dimensions are iden-
tified to show how wide-ranging meaning-centered practices can be. All authors seemed to agree
on the uniqueness of the therapeutic process, and they may take different positions on these di-
mensions with different clients in different situations. These dimensions may be regarded as a
broad toolkit, from which practitioners can use different tools in different contexts.

Unity in Diversity

Of course, there are also some fundamental differences about some unverifiable assumptions,
such as the finding or creation of meaning, and faith—or the lack thereof—in the absolute dif-
ference between what is meaningful and what is not. As Hill described, it is recommended that
practitioners are aware of their own position with different clients, for instance by imagining
how they stand on each of the dimensions shown in the Appendix. This could particularly be
relevant when they feel stuck in the process or relationship with certain clients, as this may be
due to their position. Subsequently, practitioners should inform their clients about this, and help
them to make a well-informed decision about the aim and method of therapy (Cooper & McLeod,
2011). The skills identified in this article may be used to develop educational training programs
for meaning-centered practitioners.
More evidence-based research seems required to identify the meaning of meaning for clients,
and for clinicians to use this as the basis for their practices. For example, many meaning-centered
practitioners explicitly discussed the three sources of meaning Frankl identified: experiential,
productive-creative, and attitudinal. However, there is little empirical support for this triad.
 10 J. VOS ET AL.

A systematic literature review of 108 studies with more than 45,000 participants worldwide
already showed that clients experience materialist-hedonic, self-oriented, social, higher, and
existential-philosophical meanings (Vos, 2016, 2017a; cf. Wong, 1998). Meaning-centered prac-
titioners may consider structuring some of their practices around these evidence-based sources of
meaning.
More research is needed on which clinical competency should be used with which client in
which context. Meta-analyses of 60 clinical trials show that, on average, all different meaning-
centered practices are equally effective (Vos, 2016; Vos & Vitali, 2017). That is, despite their
differences, the practices of all authors seem similarly beneficial for improving the quality of
life and reducing the level of psychological stress of clients. This meta-analysis also showed that
some skills are significantly more effective than others: using nonreligious–spiritual formulations,
structure, mindfulness/experiential exercises, practical goal-setting exercises, focusing on one
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type of meaning per session, addressing self-worth, existential limitations, coherence of time,
and establishing positive therapeutic relationships. These findings validate some of the clinical
competencies mentioned in this article. However, they are based on cross-sectional comparison,
and not on systematic experiments with different competencies.
This panel discussion shows the benefits of coming out of the silos of our individual research
and practices, sharing our experiences, and accepting our differences. We recommend organizing
more spaces for conversations like this. We can and want to find unity in diversity. As all of us
share the common aim of helping clients—each in his or her own way—to live a more meaningful
and satisfying life, despite life’s challenges.

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Appendix
Meaning-Centered Themes Identified in the Narratives from the Authors, with Examples of Authors and Texts from this Article

Pole 1 Pole 2 Key terms and phrases

General (example author) (example author) in this article

Theoretical foundations

Epistemology Monism Pluralism Common to all psychotherapies;

(there is one specific meaning (all psychotherapies address addressed in a variety of ways;
therapy) meaning) all orientations have some basic skills in working with
(e.g., Cooper, Wong) issues of meaning
Ontology Focus on being Focus on doing and reflecting Openness to life
(e.g., Schneider) (e.g., Wong)
Metaphysics Meaning is given Meaning is created Inherent meaning; can be discovered in every situation; not
(e.g., Wong) (e.g., Neimeyer) random; constructivism
Dynamism Meaning as a specific state Meaning as a dynamic process Dynamic; process
(e.g., Neimeyer)
Teleology General non-goal-oriented sense of Specific goals and purposes Goals; purposes; being and general openness to life
meaning (e.g., Cooper)
(e.g., Schneider)
Reductionism Nonreductionist Reductionist Meaning in its own right; nonpathologizing;
(e.g., Cooper) nonconceptualizing
Time orientation Past and present (“Why am I here?”) Future motivation Motives, values, desires, wants, intentions, aspirations, future
(e.g., Breitbart) (“Where am I going?”) direction
(e.g., Cooper)
Holism Primary focus on meaning and Primary focus on full flow of Full openness versus judgmental; intuition, presence to life,
positive emotions experiences mere being—doing and reflecting
(e.g., Wong) (e.g., Schneider)
Self-transcendence Individuals are always bound to their Individuals can always transcend Self-transcendence
limitations themselves and their situation
(e.g., Wong)
Absolute hierarchy No belief in the ability to know the Belief in the ability to know absolute Faith
absolute difference between the differences between the less and
less and more meaningful more meaningful
(e.g., Wong)
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The nature of meaning

Scale Meaning of specific events and Global meaningfulness of life Specific, global; coherent narrative and life story
specific experiences
(e.g., Cooper, Neimeyer) (e.g., Wong)
Relevance Meaning is sometimes relevant for Meaning is always relevant, albeit Sometimes relevant but not always; underlying cause; all
some individuals implicit psychotherapy is about meaning
(e.g., Hill; Wong)
Perceptivity Passive intuition Active creation Embodiment; active life review; interpretative;
(e.g., Schneider) (e.g., Cooper; Wong) passive—actively making sense of life story
Cognitive reflection Implicit experience and action Explicit reflections Tacit explicit knowledge—implicit; intuitive, unconscious,
(e.g., Schneider) (e.g., Wong) embodied felt sense; concept, thing—sense of awe, wonder,
mystery; tacit knowledge & skilled
performance—theoretical knowledge;
spontaneous—planned, conscious reflection; unconscious;
doing—reflecting
Affect Primary focus on specific Primary focus on the stream and Awe; experiential depth; positive psychology
(e.g., positive) emotions depth of all experiences
(e.g., Wong) (e.g., Schneider)
Behavior No primary focus on behavior Behavior, actions, goals & regulation Goals; self-regulation; behavioral
(e.g., Schneider) (e.g., Cooper)
Contextualism Meaning as primary personal process Meaning as primary social process Ethnic/cultural background/upbringing; cultural norms/values;
(e.g., Neimeyer) communal, ritual; finding meaning private thoughts and
feelings/individual—social world;
contextual-communicative process
Personal significance Not about personal significance About personal significance The person matters and is significant
(e.g., Wong)
Sources Specific sources of meanings in life General sense of meanings in life Sources or types of meaning
(e.g., Wong) (e.g., Neimeyer; Schneider)
Existential dual Focus on meaning only Focus on meaning despite Existential meaning; coping with loss
awareness meaninglessness and loss
(e.g., Wong; Neimeyer)
Range of experiences Specific emotions (e.g., positive Wide range of experiences “Whole banquet of experiences, including deepest dreads and
emotions) (e.g., Schneider) most dazzling desires”

(Continued on next page)

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Pole 1 Pole 2 Key terms and phrases
General (example author) (example author) in this article

Clinical competencies

Person-centered One-size-fits-all approach Tailored approach Discovering meaning as unique subjective process; responsive
(e.g., Cooper; Hill) to individual clients; clients are free to decide the
therapeutic approach; informed shared decision making
Nonreductionism Nonreductionist Reductionist Identify meaning concerns in own right; not pathologizing
(e.g., Cooper)
Explication of the Implicit in therapy Explicit in therapy Meaning is not a person/thing but a sense of awe
topic of meaning (e.g., Schneider) (e.g., Wong)
Self-transcendence Small focus on self-transcendence Large focus on self-transcendence Focus on something bigger than oneself and one’s situation
(e.g., Cooper) (e.g., Wong)
Validation of Primary focus on meaning Focus on meaning and validating Meaninglessness; existential meaning
meaninglessness meaninglessness
(e.g., Neimeyer)
Explicit explorations Small focus on exploring new Strong focus on the process of Explorations of meaning; sources of meaning
of new meanings meanings exploring a wide range of
meanings
(e.g., Hill; Wong)
Orientation toward Little oriented toward goals, behavior Much oriented toward goals and Setting and working toward goals; behavioral; responsibility;
goals, behavior and action behavior self-determination; action; self-regulation
and action (e.g., Cooper; Wong)
Focus on Little primary focus on the self Little primary focus on the self Creating self-awareness and self-insight; identify blocks; feel
development of the (e.g., Cooper; Wong) they matter
self
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Focus on the Small focus on practitioner–client Large focus on practitioner–client Offering support; safe, trusting setting; free
practitioner–client relationship relationship
relationship (e.g., Cooper; Hill)
Focus on creating Small focus on creating coherent Large focus on creating coherent Coherent narrative; constructivism; coherence;
coherent narratives narratives narratives comprehension; sense making
(e.g., Neimeyer; Wong)
Using specific Few specific procedures and Many specific procedures and Specific procedures, skills, and exercises
procedures techniques techniques
(e.g., Schneider) (e.g., Hill)
Focus on explicit Small focus on explicit knowledge, Large focus on explicit knowledge Unconscious work; psycho-education
knowledge (e.g., Wong)
Focus on positive Little focus on positive emotions Strong focus on positive emotions Emotional dimension, enjoyment, satisfaction, sense of
emotions (e.g., Wong) significance
Focus on acceptance Small focus on accepting reality Large focus on accepting reality Accept and confront reality; courage and coping with loss;
of reality (e.g., Wong; Neimeyer) self-transcendence; existential coping; reauthoring
Focus on restoring Small focus on conveying faith in life Large focus on conveying faith in life Believe that life is worth living; significance of the self
faith in life (e.g., Wong)

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