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Few institutions for the elderly have counselors of any kind and the question was raised to whom the elderly could seek advice or counsel. A study of the literature confirmed that even though the number of elderly persons was increasing, few counselors, psychologists, or psychiatrists had persons over 65 as clients. The problems of elderly persons cover a wide range of concerns, (physical, psychological, social) and it is obvious that a holistic approach to assist this population is necessary. Existential psychology, one of the holistic psychological theories, begins with the existing experience of the individual and proceeds to consider anything within the experience which might cause anxiety or conflict. The problems of the elderly and the concepts of existential psychology reveal a complementarity. The problems facing aging individuals were the very conflicts faced by existential counselors, e.g. fear of death, of loneliness, of freedom and responsibility, of meaninglessness in life. A systematic analysis of the complementarity between the concerns of the aged and those of existential psychology provided the foundation on which to articulate existential psychology as an ontological groundwork for counseling elderly clients. Of the few gerontological counselors, there are many who employ methods and techniques designed for younger populations, often trying to isolate problems from the client's total experience. Existential psychology considers this compartmentalization to be unrealistic for each individual exists as a whole, and is affected by the whole of one's existence. To “treat" one part of an individual's existence without regard for the whole would be unprofitable and might cause further problems. An ontological groundwork for counseling is suggested from the existential psychological point of view, and recommendations are made for carrying out such a counseling regimen. Research suggestions are delineated for future studies. / Ed. D.

Thesis advisor: Michael G. Pratt / This work focuses on an Occupational Identity Existential Threat (OIET): the experience of a possible permanent loss of an individual’s ability to claim, enact, or draw meaning from a valued occupational identity. OIETs occur among members when their occupation is in such decline that it may not survive. Identity threats from occupational demise can affect entire collectives and impact not only individuals’ identities but their relationships at and with their work; and consequently, can have important consequences on occupational members’ lives. Yet, our current theories are ill-equipped to understand how individuals experience these threats as they tend to focus on non-existential threats coming from clear losses. To address how occupational members experience an OIET, I followed a grounded theory approach and conducted an inductive qualitative study of Les Clefs d’Or concierges in the USA. I have completed about 130hrs of observations and I collected a total of 101 interviews (with 85 informants) over a period of two and a half years, plus longitudinal interviews with key occupational actors. At the occupational level, I find that the leadership of the occupation entered a ‘survival’ mode by providing support to their members, as well as narratives generating hopefulness for the maintenance of their occupation. At the individual level, I uncover several paths that Les Clefs d’Or members followed when faced with OIET: withdrawing, waiting, searching and defending. Each path had distinct outcomes on how individuals related to the occupation, as well as their mental health and relationships with other members. Finally, I describe the theoretical and practical implications of this work. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Carroll School of Management. / Discipline: Management and Organization.

Background and objectives: Stress-related illness is a growing public health problem in Sweden and it is the most common reason for sick leave today. Stress-related illness causes suffering on a number of levels and affects the patient’s health and life in the long term. The stress-related ill health also leads to consequences for society, causing high costs for sick leave and health care as well as lost workforce since people partially or entirely lose their capacity to work. Research on stress-related ill health and rehabilitation often underline work-related conditions as crucial in dealing with the problem. There is also research that points out psychosocial factors in understanding stress-related ill health. What we know little about is the existential perspective of clinical burn-out. Therefore, it is of importance to investigate people’s existential experiences of clinical burn-out and the significance of an existential perspective in rehabilitation. Aim: The overall aim of this thesis is to gain insight into the existential experience of clinical burn-out as well as to highlight the significance of an existential perspective in rehabilitation. In addition, the thesis aims to reach a deeper understanding of clinical burn-out from an existential point of view and contribute to the field with knowledge of the existential dimension of health. Methods: The study, conducted in 2011, is based on qualitative interviews made with an inductive hermeneutic approach. Five patients and seven care givers were interviewed, focusing their existential experiences of clinical burn-out as well as their experiences of rehabilitation with an existential approach. A strategic selection was made of informants in the context of a rehabilitation program with an existential approach for people diagnosed with clinical burn-out. The data was analysed in two steps. In the first step the data was interpreted with an inductive hermeneutic approach. In step two of the analysis, the data was interpreted with a deductive hermeneutic approach, using Karl Jasper’s concept of limit situation as a way of interpreting the existential experience. Aaron Antonovsky’s concept sense of coherence was used as a tool for understanding components that can contribute to restoring health. Results: In this study, the patients describe clinical burn-out as a comprehensive existential experience that can be perceived as being in between life and death, in a shadow world, trapped in a dead end. It’s a situation characterized by being powerless. It creates a need to comprehend one’s situation in order to be able to regain control and manage it. It’s a struggle to make sense of the life situation. When not being met with understanding, the patients lose hope. Existential issues in terms of meaning, existence and life choices become urgent. Working with the existential perspective requires trust, openness from both caregiver and patient, distinctness, a way to communicate it and courage to take on the challenge of dealing with existential issues. The perspective also requires that the existential suffering can be contained. Dealing with existential questions leads to self-knowledge and insights that enables a possibility to make different choices and leave negative behavioural patterns. Also, it can lead to a discovery of spirituality and religion as a resource in life. Besides their personal struggle for meaning, the patients see an existential void in society, leaving people without tools to handle existential needs. This is understood as something that affects people’s ability to handle stressful times in life. The care providers understand burn-out as a manifestation of a way of living that is not sustainable. It is an existential experience embodied in body and mind that can be experienced as being drained of life. It’s an existential challenge, causing grief when realizing one’s limitations as a human being. Also, loss of meaning and sense of existential vulnerability due to an experience of being annihilated is crucial for understanding the deep existential crisis that clinical burn-out can induce. This situation makes the patient ask existential questions about identity, meaning, values and direction. In the burnout-process the patients have distanced themselves from their own self and therefore need to reconnect with themselves. This makes the existential questions central in the rehabilitation as a way to reconnect to inner strength and resources, which are prerequisites for starting a health promoting, sustainable process which is empowering, making it possible to see oneself as a human being who experience meaning, not only as a patient with a diagnosis. Instead of finding meaning in the diagnosis, the patient’s existential questions and the existential experience is a key to moving forward, out of the situation. Meaning-making is therefore important in the rehabilitation. A holistic-existential approach and view of man makes it possible to work with the complexity of the situation. The holistic-existential approach creates synergies and offers an extra tool both for the caregiver and the patient. Focusing on the patient’s resources and competence makes it possible to see the crisis as a way to learn from it. The existential perspective in health care and rehabilitation is enabled by competence, openness, reliance, empathy and respect when meeting the patient. It also requires courage to take on the challenge of dealing with existential issues. It can be hard for both the patient and the care giver to confront existential suffering. It is the responsibility of the care giver to enable the existential perspective by acknowledging and making the existential perspective possible to communicate and work it through. The care providers understands values in modern society as contributing to people’s experience of feeling alone with existential needs, which intensifies their existential aloneness. The care providers’ experience is that the biomedical paradigm aggravates an existential perspective. The perspective is not associated with the care situation. There is a lack of knowledge about and understanding of the value of the existential perspective, all the way from the decision-making level to the clinical meeting with the patient. In addition, the paradigm affects how the patients express their illness. Also, the perspective requires time. Existential perspectives, therefore, tend to be concealed in the health care context. Applying Karl Jasper’s concept of limit situation, clinical burn-out can be interpreted as a defining existential experience. It can be understood as a limit situation when humans realize their limitations and at the same time get insights that are crucial for their lives. It’s an experience they wish they had not gone through, but on the other hand, it has led to insights they do not want to be without. The meaning-making process is health promoting by recreating meaning, the fundamental part of sense of coherence, which is crucial for a salutogenic direction. Conclusion: The existential state that the clinical burnout patients go through can, using Karl Jasper’s concept, be understood as a limit situation. According to Jasper’s reasoning, the limit situation can be perceived as facing an abyss, making it clear one has limitations as a human being. At the same time, the experience can be perceived as reaching a limit where humans can get insights about human life that can enhance life. Clinical burn-out, using Aaron Antonovsky’s concept, can be understood as a loss of the components that create sense of coherence. Loss of meaning is particularly central for understanding burn-out. Consequently, it is crucial to acknowledge the existential challenge that the patient is facing, as well as the importance of the meaning-making process for facilitating a movement in a health promoting manner. It gives a deeper understanding of the challenges and needs of patients suffering from clinical burn-out. The existential dimension of health has been highlighted in health promotion, but gets little attention in practice. This is especially significant in the health care context. This points out the need for a discussion about how the existential health dimension can be used as a resource in health care and rehabilitation and how this resource for health can be applied in a better way in health promotion and public health.

Apžvalgoje aptariamas autoriaus plėtojamas psichoterapi¬nės gru¬pės modelis egzistencinės psichoterapijos paradigmoje, vadinamas egzistencinio patyrimo grupe. Jis remiasi egzistencine žmogaus kaip būtiespasaulyje (čia-būties) sam¬rata. Psichoterapijos proceas remiasi dviem svarbiausiais grupės dalyvių gyvenimo analizės orientyrais. Pirmasis – siekimas suprasti dalyvių problemas svarbiausių gyvenimo pasaulio matmenų – fizinio, socialinio, psichologinio ir dvasinio – kontekste. Antrasis – dalyvių gyvenimo sunkumai tyrinėjami egzistencinių duotybių (universaliųjų egzistencijos sąlygų) plotmėje. Kaip svarbiausios išskiriamos šios duotybės: „įmestis į pasaulį“; santykiai su kitais; gyvenimo baigtinumas; laisvė ir atsakomybė; nerimo būsena; prasmė ir beprasmybė; laiko išgyvenimas. Egzistencinio patyrimo grupėje psichoterapinis darbas remiasi bendro grupės gyvenimo kūrimu ir dalyvių sunkumai aptariami būtent šio proceso kontekste. Apžvalgoje aptariami svarbiausi grupės funkcionavimo bruožai bei darbo būdai. Taip pat aptariama terapeuto laikysena egzistencinio patyrimo grupėje, kuri yra reikšminga psichoterapinio darbo dalis. / The review discusses a model of working with psychotherapeutic groups based on existential psychotherapy paradigm which is developed by the author and called „existential experience group“. Its main concept is the idea of human being as being-in-the world (being-there). The process of psychotherapy has two major directions, first being an attempt to understand problems of participants in the context of main dimensions – physical, social, psychological and spiritual – of human life world, and second, exploration of participants’ life difficulties in the context of existential „givens“ (universal conditions of existence). The following „givens“ are described as essential: „thrownness“ in the world, relations to others, finiteness of life, freedom and responsibility, anxiety, meaning and meaninglessness, experience of time. Psychotherapeutic work in the existential experience group is based on development of common group life, and difficulties of participants are discussed and analyzed within its context. The text reviews basic features of the group life and ways of work in it. Also considered is the position of the therapist in an existential experience group, as it is a greatly significant part of the psychotherapeutic process.

Sammanfattning Den palliativa vården karaktäriseras av en värdegrund med ledorden empati, närhet, helhet och kunskap. Syftet med värdegrunden är att främja individens livskvalitet, lindra lidande och erbjuda ett existentiellt stöd i livets slut. Grunden för en god personcentrerad vård bygger på att relation mellan vårdare, patient och närstående främjas samt att bli lyssnad på och sedd som person. Existentiell smärta är vanligt förekommande hos patienter i palliativt skede som känslor av ensamhet, isolering, meningslöshet, separation och dödsångest. Patienten ger uttryck av behov att bli bemött med respekt, empati och inte bli övergiven av sin vårdgivare. Flera studier har påvisat brister där sjukvården inte kan definiera och förstå existentiella behov. Syftet med studien var att beskriva sjuksköterskors perspektiv på att arbeta med existentiell smärta hos patienter i palliativt skede. Metoden som valdes för studien var en litteraturöversikt för att undersöka kunskapsläget inom området. Databaserna CINAHL complete, PubMed, PsycINFO samt SweMed+ genomsöktes systematiskt med valda sökord vilket resulterade i att 16 artiklar identifierades som svarade mot studiens syfte utifrån valda urvalskriterium. Resultatet visade att sjuksköterskor såg ett ansvar för att skapa en god relation och kommunikation till patient och närstående, i arbetet med existentiell smärta hos patienter i palliativt skede. Viktiga komponenter för en fördjupad relation var tid, tajming, närvaro och visad empati. Lyhördhet hos sjuksköterskan sågs som viktigt för att kunna tolka och lindra patientens existentiella smärta. Många sjuksköterskor såg arbetet som meningsfullt i de situationer då de kände att de lindrade patientens existentiella smärta. Arbetet innebar känslomässig involvering och i en del situationer var balansen mellan distans och närvaro svårt att identifiera. Arbetet öppnade även upp för reflektion kring livet och döden. En del sjuksköterskor beskrev arbetet med existentiell smärta hos patienten som för mödosamt och såg det inte som deras uppgift att sitta ner och prata om döden. Sjuksköterskorna saknade verktyg för att kunna handla och hantera i olika situationer med existentiell smärta hos patienten. Slutsatsen i föreliggande studie var sjuksköterskors möten med patienter med existentiell smärta i palliativt skede ser olika ut då varje människa är unik med olika behov och resurser. Arbetet med existentiell smärta hos patienter involverade sjuksköterskan känslomässigt och balansen mellan närvaro och distans var svår att identifiera. Mer utbildning, diskussion och träning i att bemöta existentiell smärta behövs för att stärka sjuksköterskor i deras arbete med patienten i palliativt skede. / Abstract Palliative care is characterized by a foundation of values ​​with the catchwords empathy, holism and knowledge. The purpose of the values ​​is to promote the individual's quality of life, alleviate suffering and offer an existential support in the end of life. The foundation for a good person-centered care is based on the relationship between caregiver, patient and next of kin are being promoted and being listened to and seen as a person. Existential pain is common in patients in palliative phase such as loneliness, isolation, meaninglessness, separation and death anxiety. The patient gives the expression of needs to be met with respect, empathy and not be abandoned by his caregiver. Several studies have demonstrated the gaps where the health care system can't define and understand the existential needs. The aim of the study was to describe the nurses' perspectives on working with existential pain in patients in the palliative phase. The method chosen for the study was a literature review to examine the state of knowledge in the field. The databases CINAHL complete, PubMed, PsycINFO and SweMed+ were systematically searched with selected keywords, which resulted in 16 articles being identified which corresponded to the study's aim based on the chosen selection criteria. The result showed that nurses saw a responsibility to create a good relationship and communication with the patient and next of kin, in the work with existential pain in patients in the palliative phase. Important components for a deeper relationship were time, timing, attendance and shown empathy. Responsiveness of the nurse was seen as important to be able to interpret and alleviate the patient's existential pain. Many nurses saw the work as meaningful in the situations which they felt that they alleviated the patient's existential pain. The work involved emotional involvement and in some situations where the balance between distance and presence was difficult to identify. The work also opened up for reflection on life and death. Some nurses described the work with existential pain of the patient as too laborious and did not see it as their duty to sit down and talk about death. Some nurses described that they missing tools to be able to act and handle in different situations with existential pain in the patient. Conclusion in this study, the nurses' meetings with patients with existential pain in palliative stage is different as each person is unique with different needs and resources. The work of existential pain in patients involved the nurse emotionally and the balance between the presence and distance were difficult to identify. More education, discussion and training in addressing existential pain are needed to strengthen nurses in their work with the patient in palliative phase.

The present study aimed to investigate the relationships between, personal meaning, sense of coherence, organisational commitment and selected biographical variables, specifically age, tenure and occupational level. It was found that mostly significant positive relationships exist between personal meaning and sense of coherence. Personal meaning and sense of coherence exhibit predictive value for organisational commitment. It was established that self-transcendence plays a significant role in the development of affective and normative organisational commitment. Some significant differences were found between management and non-management employees in the manifestation of personal meaning. Management approximate more personal meaning to achievement, self-acceptance, and fair treatment. On sense of coherence and organisational commitment there were no significant differences between management and non-management employees. It was recommended that the relationship between personal meaning and other positive psychology variables be researched in order to determine the significance of such relationships so as to add to this relatively new body of research. / Industrial and Organisational Psychology / M.Comm.

In this qualitative, interpretive study a new and promising imagery technique, called Wertimagination (WIM®) [Value-Oriented Imagery] was researched. It was developed by the logotherapist Uwe Boeschemeyer in Germany. At the main focus of this study are the psychotherapeutic work experiences of logotherapists applying WIM®. Their perceptions with regard to Wertimagination’s potencies, limitations and its overall contribution to Logotherapy are explored. Eight semi-structured expert interviews were conducted with German logotherapists offering WIM® at their practice. The interview contents are analysed and compared with supplementing perspectives: with Wertimagination experiences reported by other (logo)therapists, by clients and by the developer of the method (Boeschemeyer), extracted from the existing body of literature. The results show that Value-Oriented Imagery by all three researched parties – (logo)therapists, clients and its developer – is experienced to be a high potential logotherapeutic, salutogenetic (resources-oriented) approach contributing inter alia towards a person’s inner meaning finding, selfacceptance and trust in life. / Psychology / M.A. (Psychology)

The purpose of the study has been, by adopting a view of life and a learning perspective, to reach an understanding of the way in which cancer patients in a palliative care context understand and cope with their existential life situation. I asked the following questions: 1) How does their personal view of life influence the patients’ understanding and coping with the illness and existential life situation? 2) What existential questions are central to the patients? 3) What is personal learning all about? 4) What prerequisites are important for fostering the patients’ personal learning? Interviews focusing on narratives were conducted with ten patients who have an incurable cancer disease. The interviews were taped and transcribed into texts. A hermeneutic method was applied to understand the content and import of the patients’ narratives. The results show that the patients achieve closure, which involves them making reassessments, adapting their life to the illness, being reconciled with themselves and with their relation to their surroundings. It is also about them wishing to bequeath a legacy and hand down desirable qualities, values and merits for future generations. Taking this view of life as their basis, the patients interpret their illness, existential questions and life situation, and structure their existence so as to make it comprehensible and meaningful. Life narratives can serve as a tool in enabling caregivers to identify patients’ existential questions, view of life, learning requirements and the way they make sense of things (”meaning-making”). By means of view of life support counselling caregivers can identify the patients’ personal ideas, values and support their needs. The patients can reach an awareness of their personal view of life. Reappraising and developing this can be viewed as a form of perspective shift or learning.

The thesis contributes to the research field of education, or more specific to the field of religious education. The aim of the thesis is to interpret how young adults of today describe and understand their lives, with a specific focus on existential themes, and furthermore, to develop useful concepts that can help us understand individual meaning-making in a social and cultural context. The meaning-making of young people and how they explore and develop their understanding is, in the thesis, seen both as an individual process and at the same time something socially shared. The theoretical understanding of the social context takes its point of departure in Berger and Luckmann’s theory about the social construction of reality. The methodological approach is empirical and the study is based on 21 deep-interviews with men and women between 19-29 years old. Their statements are analyzed using a hermeneutic - interpretive method. The thesis gives a picture of the young adults’ understanding of death and the meaning of life. But the study also addresses vital existential themes for the young adults around the questions: who am I, what do I want to choose and where am I heading. Still another important theme is insecurity. One important contribution of the thesis is the development of new concepts that describe the young adults’ understanding of their lives, in terms of personal and shared configurations. In the material I have seen three different kinds of shared configurations and I speak of those in terms of: life-views, taken for granted perspectives and institutions. The dynamics that the personal configurations give examples of can be understood both in light of the shared configurations but also in light of the personal agency that the young adults show signs of.