Suffering is an inescapable part of life. Some suffering is so profound, so violating, or so dogged that it fundamentally changes people in indelible ways. Many existing therapeutic approaches, from a medical model, treat suffering as mental illness and seek a curative solution. However, such approaches often fail to examine the deep questions that suffering elicits (e.g., existential themes of death, isolation, freedom, identity, and meaninglessness) and the far-reaching ways in which suffering affects the lived experience of each individual.
In The Courage to Suffer, Daryl and Sara Van Tongeren introduce a new therapeutic framework that helps people flourish in the midst of suffering by cultivating meaning.
Drawing from scientific research, clinical examples, existential and positive psychology, and their own personal stories of loss and sorrow, Daryl and Sara's integrative model blends the rich depth of existential clinical approaches with the growth focus of strengths-based approaches.Through cutting edge-research and clinical case examples, they detail five "phases of suffering" and how to work with a client's existential concerns at each phase to develop meaning. They also discuss how current research suggests to build a flourishing life, especially for those who have endured, and are enduring, suffering.
Daryl and Sara show how those afflicted with suffering, while acknowledging the reality of their pain, can still choose to live with hope.
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Yes, you can access Spirituality and Mental Health by Daryl R. Van Tongeren,Sara A. Showalter Van Tongeren in PDF and/or ePUB format, as well as other popular books in Psychology & History & Theory in Psychology. We have over one million books available in our catalogue for you to explore.
âBut there was no need to be ashamed of tears, for tears bore witness that a man had the greatest of courage, the courage to suffer.â âVIKTOR E. FRANKL, Manâs Search for Meaning
OUR LIVES have been profoundly shaped by suffering.
In early 2010, we were beginning to build our careers and felt the promise of a somewhat expected future. Sara, while completing her supervision hours toward her clinical license, was working with families of children with chronic and significant medical needs. Daryl was completing his fourth year of doctoral work and was in the thick of dissertation research studying how people find meaning in life, with hopes of going on the academic job market in the fall. We were feeling settled, so we started trying to get pregnant. And like most people, we didnât notice that life was going as planned.
Four months later, everything changed.
In April, we received a phone call that upended our world and irrevocably altered our lives. Darylâs brother Tim underwent surgery that did not go as expected. We immediately flew to Colorado to be with family. Within a few short weeks, Tim died at age thirty-four, leaving his wife to raise their three young children under the age of six. Because of the genetic nature of Timâs illness, there was a high likelihood that we would experience a similar fate as Tim and his wife. We were haunted by the existential question: Would Daryl develop the same condition that took Timâs life? To compound our grief, one specialist stated that, given the genetic nature of Timâs condition, we should not have children. It was one loss after another.
Years after this devastating blow to our dreams and our identity, we began to seek consultation and additional specialistsâ opinions, who eventually gave us the green light to start a family. Our lost dream was given new hope. However, after almost two years of trying, we were told, with a sense of finality, that we would not be parents. Our infertility diagnosis further added to our grief, and our suffering was palpable. This pain and those experiences had become part of us and in many ways shaped us; how could we remove the pain or forget our experiences? We sought the help of friends and professionals, but the reality was we could not be unbroken. This was now our story.
THE NEED FOR A NEW APPROACH TO SUFFERING
As a professionally trained psychologist and clinical social worker, respectively, we challenged every cognitive distortion that we had: âour life was overâ (catastrophizing), âthis is all our faultâ (personalizing), âweâre inadequateâ (emotional reasoning), and we were still left with the simple fact that we would not be parents and that Darylâs genetic future was unknown. However, our story was not a cognitive distortion; our suffering was not a set of irrational thoughts that needed to be corrected. No amount of therapeutic mental gymnastics could make us feel unbroken. We needed a new approachâa completely different way to think about suffering that allowed us to hold the pain in authentic ways while desperately seeking to flourish.
Clinical work has long focused on alleviating suffering. However, not every therapeutic model is designed to help those in persistent, recurring, or unsolvable suffering. Many perspectives approach mental health concerns as discrete negative events that can be directly resolved through cognitive adaptation, emotion regulation, or behavioral modification strategies. Boiled down to its most basic level, many clinical approaches view suffering as a problem to be fixed, and then, once the symptoms subside, disregard the effect of the event itself. This strategy falls short, however, when the event and its effects have fundamentally changed the individualâs life and cannot be resolved. There is no fixing death, infertility, loss of a dream, or the permanent shift of oneâs identity. Instead, these approaches must account for deeply painful situations that alter your clientâs life in ways that cannot be reversed or solved. Our framework is designed precisely for such situations. Put succinctly, we posit that suffering is an inherent part of life that must be engaged. And we suggest that your clinical approach should embody that truth.
OVERVIEW OF FRAMEWORK
We propose an existential positive psychology approach to suffering. It highlights the necessity of identifying the core concerns underlying each personâs experience, as well as the importance of building strong relationships, values, and virtues as ways to promote flourishing in the midst of suffering. It is unique from other clinical approaches in that the centerpiece of this model is cultivating meaning, a component shared by both existential and positive psychology perspectives. Synthesizing these frameworks can provide a rich approach to engage your clients in their darkest and most difficult times of life, by honoring their pain and finding ways to experience a rich and full life during that pain.
Existential approaches to psychotherapy, popularized by individuals such as Viktor Frankl and Irvin Yalom, contend that anxiety and suffering arise, in part, from the persistent isolation of all humans and the inherent meaninglessness of the world, where the only certainty is death.1,2 Each person is inherently alone and is wired to find ways to connect with others and create meaning while they are alive. Part of the existential process is accepting, and coming to terms with, these givens of human existence. Our approach provides a pathway for exploring the depth of your clientâs situation by examining what central fears are uncovered by their suffering and how it may be affecting their ability to flourish. As people identify core features of human existence as root causes of their suffering, they can learn to create meaning from within, rather than expecting to find meaning from the outsideâregardless of their circumstances.
Meaning is also a central feature of the positive psychology movement, which developed as a response to the majority of psychological research and clinical work that had focused solely on viewing people through the lens of mental disorders and abnormal functioning.3 Psychology had become narrowly focused on the negative: distress, dysfunction, disorders, and disease. But this focus on the negative provides an incomplete view of human nature. Positive psychology addresses that âother halfâ by emphasizing how character strengths, virtues, and meaning contribute to the good life. In short, whereas most other psychological perspectives help people cope with mental illness, positive psychology helps people cultivate full and flourishing lives.
The synergistic blend of the existential psychology perspective and the positive psychology perspective creates a shared goal: building meaning in all circumstances. Drawing from existential and positive psychology,4 our approach examines the deep, underlying existential concerns that suffering exposes, while focusing on building meaning and promoting a full, whole life that is marked by authenticity and concern for others. This approach requires balancing both motivations of depth and growth: Without sufficient depth, your clients will not fully address the core root of their suffering; and without sufficient growth, your clients may stagnate and become overwhelmed by feelings of hopelessness, depression, and despair. Your role as therapist is to help your clients engage both motivations by helping them cultivate meaning. This intersection of perspectives is depicted in Figure 1.
FIGURE 1. The existential positive psychology framework.
DEFINING TERMS: SUFFERING, MEANING, AND HOW THE TWO RELATE
Before we describe how to work with your clients in the process of suffering, it is important to define suffering and meaning, and clarify how to approach the relationship between the two concepts.
The Difference between Pain and Suffering
Pain exists when your client is experiencing an event or a pattern of thinking that (a) is explainable (i.e., has a clear source or reason), (b) has a relatively distinct trajectory (i.e., appears to be resolvable given enough time), and (c) is relatively focused (i.e., affects one primary area of life); in such cases, your typical therapeutic approaches may be sufficient. Consider a client who seeks support after the expected death of an elderly parent. Most therapeutic approaches, such as cognitive-behavioral therapy (CBT), are well-suited to help a client alter their thoughts about a parentâs death, help them process their grief, encourage them to explore and express their emotions, and begin to navigate relational changes in their family. In situations like these, the clientâs pain has an easily identifiable source and can be addressed by your usual treatment modalities.
However, other forms of emotional pain are qualitatively different. Whereas pain may have some form of a solution, suffering is persistent and may not be resolvable. Some suffering is so profound, so violating, or so dogged, that it fundamentally changes people in indelible ways and forces them to come to terms with core existential realities of life. Situations like these are unexplainable or violating, persistent and enduring, and fundamentally life-changing. You can experience pain without suffering, but you cannot experience suffering without pain. Our approach is designed to help you work with clients who are suffering.
Consider a client who seeks support after the expected death of a parent from amyotrophic lateral sclerosis (ALS), a genetic and heritable disease that also has implications that affect not only your client but the immediate family as well. The death of their parent elicits existential concerns about their own death and the lives of their children. You could attempt to employ a CBT approach and help the client reframe how they think about dying or help them cope with the emotional distress of losing a parent, but you would be working from a limited perspective that only addresses a resolution from the aspect of losing a parent. What do you do with the very real idea that your clientâs own health is at risk and that they will have to live with that uncertainty? Our approach acknowledges that the pain your client feels is valuable and must be wrestled with and integrated, not removed. Instead, your client can learn to bear this pain.
What Is Meaning?
Building meaning is the key to helping your clients who are suffering. We define meaning as the subjective feeling that my experiences and life make sense, matter, and are purposeful.5 Researchers agree that there are three main components of meaning: coherence, significance, and purpose.6 A sense of coherence arises when people can make sense of eventsâwhen their experiences fit into their worldview or set of beliefs. People usually feel coherence when they explain why things happened in a way that is consistent with how they see the world. The central question pertaining to coherence is: Does this make sense?
People experience significance when they feel like they have worth, value, and that they matter or feel connected to something larger than themselves. People usually feel significant when they have reciprocal relationships, when their work is consequential, and when they are making a positive, lasting contribution to the world. The central question pertaining to significance is: Do I matter?
People achieve a sense of purpose when they have broader intentions toward which they can place their energy and effort. A sense of purpose gives people a reason for their actions and helps frame your clientâs sense of identity. The central question pertaining to purpose is: Why am I here?
Each facet of meaning acts as a protective factor during times of suffering. Coherence translates events in ways that make sense; significance helps people transcend themselves and connect with others; and purpose transforms experiences, including pain and suffering, into something greater.
Meaning and Happiness Are Not the Same
People may use the terms âmeaningâ and âhappinessâ interchangeably, but itâs important to distinguish the difference between the two concepts. As an example, parents often report less marital satisfaction after having children compared to nonparents.7 In addition, the more children a couple has, the less satisfied they are in their relationship. Cross-cultural research confirms these results and also shows that Americans experience the strongest negative effects.8 Yet most of these parents would likely report that having a child is incredibly meaningful and significant; the meaning, not necessarily happiness, derived from parenting is what contributes to parental well-being.9 Despite its strain on happiness, many do not forgo being parents in order to be happier. They choose meaning.
Another study directly compared happiness and meaning to clarify how they differ. People report being happy when stress, struggles, and negative events are largely absent. Meaning, in ...
