The International Journal of the Addictions, 14(6), 847-853, 1979
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
Research Note
Treatment of Alcoholics with Logotherapy James C. Crumbaugh, Ph.D. Gordon L. Carr, Ph.D. Gulfport Division Veterans Administration Center Biloxi, Mississippi 3953 1
Abstract This study evaluates the results of group logoanalysis with selected hospitalized alcoholics using the Purpose in Life (PIL) Test as a before-and-after measure of therapeutic outcome in comparison with controls. Results suggest that closed-end logoanalysis groups are superior to open-end groups, and that both are superior to controls in improving the patient’s sense of meaning and purpose in life as measured by the PIL. Studies with the Purpose in Life (PIL) Test (Crumbaugh and Maholick, 1964, 1969), an attitude scale designed from the orientation of Frankl’s logotherapy, suggest that from 25 to 35% of alcoholics manifest a primary problem of lacking a meaning and purpose in life. (The Purpose in Life Test is published with a complete manual of instructions, norms, and technical data by Psychometric Affiliates, P.O. Box 3167, Munster, Indiana 46321.) The aim of logotherapy (Frankl, 1955, 1963) is to guide 847 Copyright @ 1979 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
848
CRUMBAUGH AND CARR
the patient in finding this meaning. The present study evaluates the results of group logoanalysis, a special application of logotherapy (Crumbaugh, 1973), with selected hospitalized alcoholics, using the Purpose in Life (PIL) Test as a before-and-after measure of therapeutic outcome, in comparison with alcoholic controls treated in the same hospital program except without logoanalysis. In an earlier study by Crumbaugh (1972) similar comparisons of logotherapy using closed-end groups yielded a consistent superiority for logotherapy on PIL scores. In more recent work it became necessary for practical reasons to take new patients into a continuing group on an openend basis, which meant that the patient experienced something similar to entering a movie in the middle of the show. In time the practical situation changed in the hospital program so that closed-end groups could be resumed, and the present study compares the two conditions. In addition, the earlier study had found that, while the logoanalysis patients had been selected on criteria entirely independent of initial or intake PIL scores, those patients whose initial scores were low (suggesting a lack of meaning and purpose in life and a need to find one) responded much better on posttherapy PIL scores than did patients whose initial PIL scores were above the normative cutting score of 92.5. The suggestion was that indiscriminate selection of patients without reference to initial score will result in washing out a good deal of the before-and-after therapy PIL differences, and will thus reduce the PIL’s effectiveness in distinguishing different treatment groups. On the other hand, selection of cases on the basis of initial score will maximize the scale’s ability to make such discriminations. The present study also tests this point. The present hypotheses are: (1) The PIL will in all three groups (openend logoanalysis, closed-end logoanalysis, and controls) show a significant rise in scores after therapy. (2) In the analysis of the subgroups representing before-therapy PIL scores of 93 or above, there will not necessarily be a significant difference between groups on the after-therapy measure, since subjects who score high on the PIL before-therapy are supposed to have a purpose in life and therefore should not gain much by the additional search for one. (3) In the subgroups representing beforetherapy PIL scores of 92 or below, these subjects are supposed to lack a purpose in life and should find one through therapy; therefore the analysis of these subgroups will show a significant difference between each of the three groups and the other two on the after-therapy measure, with the means in the following order: controls lowest, open-end middle, closedend highest. (4) In these subgroups representing before-therapy PIL scores
TREATMENT OF ALCOHOLICS WITH LOGOTHERAPY
849
of 92 or below, the closed-end logoanalysis group will be superior to the open-end group as measured by after-therapy PIL scores.
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
METHOD Subjects
From a pool of Veterans Administration Hospital Alcoholism Treatment Unit (ATU) patients meeting the basic logotherapy referral criteria, individuals were selected randomly to form six groups ( N = 25 each). Group Z-A : Open-end logoanalysis patients with before-therapy PIL scores of 93 or above. Group Z-B:Open-end logoanalysis patients with before-therapy PIL scores of 92 or below. Group IZ-A: Closed-end logoanalysis patients with before-therapy scores of 93 or above. Group ZZB : Closed-end logoanalysis patients with before-therapy scores of 92 or below. Group HI-A : Controls: ATU patients not receiving logoanalysis with intake PIL scores of 93 or above. Group ZZZ-B: Controls: ATU patients not receiving logoanalysis with intake scores of 92 or below. All logoanalysis patients were tested on the PIL at the initiation of therapy and again at the conclusion of therapy. The therapeutic interval was 3 weeks. Controls were tested at intake into the ATU and at exit from it, an interval of 28 days to 6 weeks. The longer “before-and-after” interval for controls mitigated against the hypotheses and therefore is on the side of safety: The extra time should have allowed more therapeutic benefits in the control group. Procedure
Procedure f o r Logoanalysis. Logoanalysis was conducted as follows. Groups met four times a week in 2-hour sessions. The first writer’s book (Crumbaugh, 1973) was used as a “text.” Logoanalysis is distinguished from general logotherapy by (1) emphasis on the search for meaning by everyday people rather than by “sick” or “abnormal” people, and (2) special exercises used to apply the generic principles of logotherapy established by Frankl. (An unabridged version of this paper containing greater details of procedure and results will be sent upon request. Address J. C . Crumbaugh c/o Psychology Service, Veterans Administration Center, Gulfport Division, Biloxi, Mississippi 39531 .) Group I1 members worked through the book from beginning to end in the fashion of an academic class. The difference between Groups I and I1 is, as noted earlier,
CRUMBAUGH AND CARR
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
850
similar to that between entering a movie during its progress and entering at the beginning. Procedure for Controls. The ATU was a Jellinek-type program with daily morning lectures and movies on various aspects of alcoholism, with afternoon group therapy, and adjunctive occupational therapy, physical exercise, and Alcoholics Anonymous contacts.
RESULTS Means of all distributions are presented in Table 1. Overall analysis of variance of the groups with before-therapy PIL scores of 93 and above (Table 2) reveals significant treatment effects but no significant group effects. The analysis of variance of the groups with before-therapy PIL scores of 92 and below shows significant treatment effects, significant group treatment interaction, and significant group effects. Because of significant interaction, direct interpretation of significant main effects of groups for the analysis of subjects initially scoring 92 or below would be misleading. Therefore an analysis of simple main effects was computed (Winer, 1962, p. 232), followed by planned individual comparisons of elements within significant simple main effects (Table 3). These analyses, coupled with inspection of the means in Table 1, reveal that there are no significant differences in groups before-therapy, but that the after-therapy group differences are significant. For all three groups the treatment effects (before-and-after therapy differences) are significant. Breaking the after-therapy group differences down by planned comparisons reveals that there is no significant difference between Group I (open-end logoanalysis) and Group I1 (closed-end logoanalysis), and no Table 1 Means of Treatment Groups by Initial PIL Score and Therapy Status (trials). N in each cell = 25 -~
~~-
Before therapy ~
Before-therapy PIL scores of 93 and up: Group I (openend) Group I1 (closed-end) Group 111 (control) Before-therapy PIL scores of 92 and down: Group I (open-end) Group I1 (closed-end) Group 111 (control)
~
After therapy
~~~~~
108.28 110.00 107.12
111.16 118.64 110.12
75.68 73.68 69.00
95.32 101.80 84.08
TREATMENT OF ALCOHOLICS WITH LOGOTHERAPY
851
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
Table 2 Overall Analyses of Variance
Source of variance
Before therapy PIL scores of 93 and up
Before therapy PIL scores of 92 and down
Mean SS
F
Mean SS
df
2.42
2,256
2
Between Ss: A (groups) Error variance within groups Within Ss: B (before-after) A x B (interaction) Error variance within Ss (B x Ss)
df
457
2
I89
72
878 136
1 2
62
72
391.63 14.16** 2.19
F
5.76**
72
16,454 548
1 2
101
72
162.91.' 5.43**
**Significant at p < .01.
significant difference ( p < .lo) between Group I and Group I11 (controls), but that the difference between Group I1 and Group I11 is significant (p < .01).
DISCUSSION The results support Hypothesis 1 (that the PIL would show a significant rise in PIL scores after therapy for all three groups) and Hypothesis 2 (that there would not necessarily be a significant difference Table 3 Analysis of Simpfe Effects for Before- Therapy PIL Scores of 92 and Befow
Source of variance
Mean SS
F
df ~
Groups, before-therapy Groups, after-therapy Error within cells
293.86 2009.70 492.63
Before-after, Group I Before-after, Group I1 Before-after, Group I11 Error before-after within groups
4821.62 9884.18 2842.58 101
*Significant at p < .05. **Significant at p < .01.
2 2
.60 4.08*
72
1
1 1 72
47.74** 97.86** 28.14**
CRUMBAUGH A N D CARR
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
852
in after-therapy PIL scores between the three groups for cases with beforetherapy PIL scores of 93 or above). Hypothesis 3 (that there would be a significant difference in after-therapy PIL scores between each of the three groups and the other two for cases scoring 92 or below on the beforetherapy PIL measure) was partially supported, i.e., the means were in the predicted order: the control mean was lowest, and open-end logoanalysis mean was next, and the closed-end logoanalysis mean was highest. There was no significant difference in after-therapy PIL scores between the control and open-end logoanalysis groups, and no significant difference in after-therapy scores between the open-end and the closed-end logoanalysis groups, but there was a significant difference between the control and the closed-end logoanalysis groups. This latter fact also supports Hypothesis 4 (that for cases whose before-therapy PIL scores were 92 or below, closed-end logoanalysis would be superior to open-end logoanalysis), i.e., the means were in the predicted order, and the closed-end group was significantly higher than the control group whereas the openend group was not. The question might be raised as to whether lack of significance in the analysis of higher initial PIL scores could be due to a ceiling effect. Although no PIL score hit the possible range ceiling, there could still be an effect of regression toward the mean. In this regard it should be noted, however, that the obtained results are those to be expected psychologically: Subjects who initially possess a high degree of life meaning should have little need for more and should therefore be little motivated in this direction in therapy. Future utilization of logotherapy with alcoholism treatment programs may consider from a clinical standpoint employment of this therapeutic modality with those patients most likely to benefit (low initial PIL), and may develop alternative interventions for patients with high initial PIL scores. No significant alterations in general policies are required to include logotherapy in such programs; in fact, one strength is its ability to serve adjunctively almost any other modality. A profitable direction of future research would be to study the relationship between PIL scores at successive follow-up intervals and behavioral changes related to sobriety. ACKNOWLEDGMENT
This research was supported by the Medical Research Service of the Veterans Administration.
TREATMENT OF ALCOHOLICS WITH LOGOTHERAPY
853
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
REFERENCES CRUMBAUGH, J.C. Changes in Frankl’s existential vacuum as a measure of therapeutic outcome. Newslet. Res. Psychol. (VA Center, Bay Pines, Florida) 14(2): 35-37. 1972. CRUMBAUGH, J.C. Everything to Gain: A Guide to Self-Fulfillment through Logoanalysis. Chicago: Nelson-Hall, 1973. CRUMBAUGH, J.C., and MAHOLICK, L.T. An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. J. Clin. Psychol. 20: 200-207, 1964. CRUMBAUGH, J.C., and MAHOLICK, L.T. The Purpose in Life Test (manual of instructions, test booklets). Munster, Indiana: Psychometric Affiliates (Post Office Box 31671, 1969. FRANKL, V.E. The Doctor and the Soul. New York: Knopf, 1955. FRANKL, V.E. Man$ Search for Meaning. New York: Washington Square Press, 1963. WINER, B.J. Statistical Principles in Experimental Design. New York: McGraw-Hill, 1962.
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
Research Note
Treatment of Alcoholics with Logotherapy James C. Crumbaugh, Ph.D. Gordon L. Carr, Ph.D. Gulfport Division Veterans Administration Center Biloxi, Mississippi 3953 1
Abstract This study evaluates the results of group logoanalysis with selected hospitalized alcoholics using the Purpose in Life (PIL) Test as a before-and-after measure of therapeutic outcome in comparison with controls. Results suggest that closed-end logoanalysis groups are superior to open-end groups, and that both are superior to controls in improving the patient’s sense of meaning and purpose in life as measured by the PIL. Studies with the Purpose in Life (PIL) Test (Crumbaugh and Maholick, 1964, 1969), an attitude scale designed from the orientation of Frankl’s logotherapy, suggest that from 25 to 35% of alcoholics manifest a primary problem of lacking a meaning and purpose in life. (The Purpose in Life Test is published with a complete manual of instructions, norms, and technical data by Psychometric Affiliates, P.O. Box 3167, Munster, Indiana 46321.) The aim of logotherapy (Frankl, 1955, 1963) is to guide 847 Copyright @ 1979 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
848
CRUMBAUGH AND CARR
the patient in finding this meaning. The present study evaluates the results of group logoanalysis, a special application of logotherapy (Crumbaugh, 1973), with selected hospitalized alcoholics, using the Purpose in Life (PIL) Test as a before-and-after measure of therapeutic outcome, in comparison with alcoholic controls treated in the same hospital program except without logoanalysis. In an earlier study by Crumbaugh (1972) similar comparisons of logotherapy using closed-end groups yielded a consistent superiority for logotherapy on PIL scores. In more recent work it became necessary for practical reasons to take new patients into a continuing group on an openend basis, which meant that the patient experienced something similar to entering a movie in the middle of the show. In time the practical situation changed in the hospital program so that closed-end groups could be resumed, and the present study compares the two conditions. In addition, the earlier study had found that, while the logoanalysis patients had been selected on criteria entirely independent of initial or intake PIL scores, those patients whose initial scores were low (suggesting a lack of meaning and purpose in life and a need to find one) responded much better on posttherapy PIL scores than did patients whose initial PIL scores were above the normative cutting score of 92.5. The suggestion was that indiscriminate selection of patients without reference to initial score will result in washing out a good deal of the before-and-after therapy PIL differences, and will thus reduce the PIL’s effectiveness in distinguishing different treatment groups. On the other hand, selection of cases on the basis of initial score will maximize the scale’s ability to make such discriminations. The present study also tests this point. The present hypotheses are: (1) The PIL will in all three groups (openend logoanalysis, closed-end logoanalysis, and controls) show a significant rise in scores after therapy. (2) In the analysis of the subgroups representing before-therapy PIL scores of 93 or above, there will not necessarily be a significant difference between groups on the after-therapy measure, since subjects who score high on the PIL before-therapy are supposed to have a purpose in life and therefore should not gain much by the additional search for one. (3) In the subgroups representing beforetherapy PIL scores of 92 or below, these subjects are supposed to lack a purpose in life and should find one through therapy; therefore the analysis of these subgroups will show a significant difference between each of the three groups and the other two on the after-therapy measure, with the means in the following order: controls lowest, open-end middle, closedend highest. (4) In these subgroups representing before-therapy PIL scores
TREATMENT OF ALCOHOLICS WITH LOGOTHERAPY
849
of 92 or below, the closed-end logoanalysis group will be superior to the open-end group as measured by after-therapy PIL scores.
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
METHOD Subjects
From a pool of Veterans Administration Hospital Alcoholism Treatment Unit (ATU) patients meeting the basic logotherapy referral criteria, individuals were selected randomly to form six groups ( N = 25 each). Group Z-A : Open-end logoanalysis patients with before-therapy PIL scores of 93 or above. Group Z-B:Open-end logoanalysis patients with before-therapy PIL scores of 92 or below. Group IZ-A: Closed-end logoanalysis patients with before-therapy scores of 93 or above. Group ZZB : Closed-end logoanalysis patients with before-therapy scores of 92 or below. Group HI-A : Controls: ATU patients not receiving logoanalysis with intake PIL scores of 93 or above. Group ZZZ-B: Controls: ATU patients not receiving logoanalysis with intake scores of 92 or below. All logoanalysis patients were tested on the PIL at the initiation of therapy and again at the conclusion of therapy. The therapeutic interval was 3 weeks. Controls were tested at intake into the ATU and at exit from it, an interval of 28 days to 6 weeks. The longer “before-and-after” interval for controls mitigated against the hypotheses and therefore is on the side of safety: The extra time should have allowed more therapeutic benefits in the control group. Procedure
Procedure f o r Logoanalysis. Logoanalysis was conducted as follows. Groups met four times a week in 2-hour sessions. The first writer’s book (Crumbaugh, 1973) was used as a “text.” Logoanalysis is distinguished from general logotherapy by (1) emphasis on the search for meaning by everyday people rather than by “sick” or “abnormal” people, and (2) special exercises used to apply the generic principles of logotherapy established by Frankl. (An unabridged version of this paper containing greater details of procedure and results will be sent upon request. Address J. C . Crumbaugh c/o Psychology Service, Veterans Administration Center, Gulfport Division, Biloxi, Mississippi 39531 .) Group I1 members worked through the book from beginning to end in the fashion of an academic class. The difference between Groups I and I1 is, as noted earlier,
CRUMBAUGH AND CARR
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
850
similar to that between entering a movie during its progress and entering at the beginning. Procedure for Controls. The ATU was a Jellinek-type program with daily morning lectures and movies on various aspects of alcoholism, with afternoon group therapy, and adjunctive occupational therapy, physical exercise, and Alcoholics Anonymous contacts.
RESULTS Means of all distributions are presented in Table 1. Overall analysis of variance of the groups with before-therapy PIL scores of 93 and above (Table 2) reveals significant treatment effects but no significant group effects. The analysis of variance of the groups with before-therapy PIL scores of 92 and below shows significant treatment effects, significant group treatment interaction, and significant group effects. Because of significant interaction, direct interpretation of significant main effects of groups for the analysis of subjects initially scoring 92 or below would be misleading. Therefore an analysis of simple main effects was computed (Winer, 1962, p. 232), followed by planned individual comparisons of elements within significant simple main effects (Table 3). These analyses, coupled with inspection of the means in Table 1, reveal that there are no significant differences in groups before-therapy, but that the after-therapy group differences are significant. For all three groups the treatment effects (before-and-after therapy differences) are significant. Breaking the after-therapy group differences down by planned comparisons reveals that there is no significant difference between Group I (open-end logoanalysis) and Group I1 (closed-end logoanalysis), and no Table 1 Means of Treatment Groups by Initial PIL Score and Therapy Status (trials). N in each cell = 25 -~
~~-
Before therapy ~
Before-therapy PIL scores of 93 and up: Group I (openend) Group I1 (closed-end) Group 111 (control) Before-therapy PIL scores of 92 and down: Group I (open-end) Group I1 (closed-end) Group 111 (control)
~
After therapy
~~~~~
108.28 110.00 107.12
111.16 118.64 110.12
75.68 73.68 69.00
95.32 101.80 84.08
TREATMENT OF ALCOHOLICS WITH LOGOTHERAPY
851
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
Table 2 Overall Analyses of Variance
Source of variance
Before therapy PIL scores of 93 and up
Before therapy PIL scores of 92 and down
Mean SS
F
Mean SS
df
2.42
2,256
2
Between Ss: A (groups) Error variance within groups Within Ss: B (before-after) A x B (interaction) Error variance within Ss (B x Ss)
df
457
2
I89
72
878 136
1 2
62
72
391.63 14.16** 2.19
F
5.76**
72
16,454 548
1 2
101
72
162.91.' 5.43**
**Significant at p < .01.
significant difference ( p < .lo) between Group I and Group I11 (controls), but that the difference between Group I1 and Group I11 is significant (p < .01).
DISCUSSION The results support Hypothesis 1 (that the PIL would show a significant rise in PIL scores after therapy for all three groups) and Hypothesis 2 (that there would not necessarily be a significant difference Table 3 Analysis of Simpfe Effects for Before- Therapy PIL Scores of 92 and Befow
Source of variance
Mean SS
F
df ~
Groups, before-therapy Groups, after-therapy Error within cells
293.86 2009.70 492.63
Before-after, Group I Before-after, Group I1 Before-after, Group I11 Error before-after within groups
4821.62 9884.18 2842.58 101
*Significant at p < .05. **Significant at p < .01.
2 2
.60 4.08*
72
1
1 1 72
47.74** 97.86** 28.14**
CRUMBAUGH A N D CARR
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
852
in after-therapy PIL scores between the three groups for cases with beforetherapy PIL scores of 93 or above). Hypothesis 3 (that there would be a significant difference in after-therapy PIL scores between each of the three groups and the other two for cases scoring 92 or below on the beforetherapy PIL measure) was partially supported, i.e., the means were in the predicted order: the control mean was lowest, and open-end logoanalysis mean was next, and the closed-end logoanalysis mean was highest. There was no significant difference in after-therapy PIL scores between the control and open-end logoanalysis groups, and no significant difference in after-therapy scores between the open-end and the closed-end logoanalysis groups, but there was a significant difference between the control and the closed-end logoanalysis groups. This latter fact also supports Hypothesis 4 (that for cases whose before-therapy PIL scores were 92 or below, closed-end logoanalysis would be superior to open-end logoanalysis), i.e., the means were in the predicted order, and the closed-end group was significantly higher than the control group whereas the openend group was not. The question might be raised as to whether lack of significance in the analysis of higher initial PIL scores could be due to a ceiling effect. Although no PIL score hit the possible range ceiling, there could still be an effect of regression toward the mean. In this regard it should be noted, however, that the obtained results are those to be expected psychologically: Subjects who initially possess a high degree of life meaning should have little need for more and should therefore be little motivated in this direction in therapy. Future utilization of logotherapy with alcoholism treatment programs may consider from a clinical standpoint employment of this therapeutic modality with those patients most likely to benefit (low initial PIL), and may develop alternative interventions for patients with high initial PIL scores. No significant alterations in general policies are required to include logotherapy in such programs; in fact, one strength is its ability to serve adjunctively almost any other modality. A profitable direction of future research would be to study the relationship between PIL scores at successive follow-up intervals and behavioral changes related to sobriety. ACKNOWLEDGMENT
This research was supported by the Medical Research Service of the Veterans Administration.
TREATMENT OF ALCOHOLICS WITH LOGOTHERAPY
853
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 12/20/14 For personal use only.
REFERENCES CRUMBAUGH, J.C. Changes in Frankl’s existential vacuum as a measure of therapeutic outcome. Newslet. Res. Psychol. (VA Center, Bay Pines, Florida) 14(2): 35-37. 1972. CRUMBAUGH, J.C. Everything to Gain: A Guide to Self-Fulfillment through Logoanalysis. Chicago: Nelson-Hall, 1973. CRUMBAUGH, J.C., and MAHOLICK, L.T. An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. J. Clin. Psychol. 20: 200-207, 1964. CRUMBAUGH, J.C., and MAHOLICK, L.T. The Purpose in Life Test (manual of instructions, test booklets). Munster, Indiana: Psychometric Affiliates (Post Office Box 31671, 1969. FRANKL, V.E. The Doctor and the Soul. New York: Knopf, 1955. FRANKL, V.E. Man$ Search for Meaning. New York: Washington Square Press, 1963. WINER, B.J. Statistical Principles in Experimental Design. New York: McGraw-Hill, 1962.
