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Home , Association (psychology), Behavior modification, Family therapy, Narrative therapy, Noogenic neurosis, Paradoxical intention

Paul T. P. Wong Trinity Western University, British Columbia, Canada

I. Introduction Known as the “Third Viennese School of Psychother- II. The Spiritual Dimension apy,” logotherapy was developed in the 1930s because of III. The of Meaning Frankl’s dissatisfaction with both and Adler. IV. Basic Tenets Frankl accepts ’s concept of uncon- V. Existential Frustration and Noogenic sciousness but considers the to meaning as more VI. Logotherapeutic Techniques and Applications VII. Recent Developments fundamental than the will to . Existential Further Reading analysis is designed to bring to the “hid- den” meaning or spiritual dimension of the client. Frankl received training in individual GLOSSARY from Adler. He differs from Adler because he focuses on the will to meaning, while Adler emphasizes social dereflection A logotherapeutic technique to redirect clients’ away from their problems to more positive as- interest and the . However, some of the pects of their lives. It is built on the human capacity for basic concepts of logotherapy, such as freedom and re- self-distancing and self-transcendence. sponsibility, bear the imprint of Adler’s influence. existential analysis Developed by , it refers to A major difference between logotherapy and psycho- therapeutic techniques that bring the hidden meaning of analysis is that both Freud and Adler focus on the past, existence into consciousness. while logotherapy focuses rather on the future—on the logotherapy Developed by Viktor Frankl, it refers to a spiri- meanings to be fulfilled. tually, existentially oriented that seeks to achieve Although logotherapy and existential analysis tend healing and health through meaning. meaning-centered counseling and therapy Developed by Paul to be used interchangeably or together as a single label, T. P. Wong, it focuses on the transformation of cognitive it may be helpful to recognize the following difference meanings as well as life’s purposes. It integrates both cog- between these two terms: nitive-behavioral and narrative processes. Logotherapy means therapy through meaning, and it A logotherapeutic technique to encour- refers to Frankl’s spiritually oriented approach to psy- age the patient to do or wish to happen what the patient chotherapy. Existential analysis, on the other hand, refers fears. It is built on the human capacity for self-detachment. to the analytical therapeutic process involved in address- ing the patient’s spiritual, existential needs. To the extent I. INTRODUCTION that logotherapy makes the patient aware of the hidden meaning of existence, it is an analytical process. This article will present an overview of Viktor Frankl’s Logotherapy is a distinct branch of existential–hu- (1905–1997) logotherapy and existential analysis. manistic school , because of its focus on

Encyclopedia of Psychotherapy Copyright 2002, Elsevier Science (USA). VOLUME 2 107 All rights reserved. 108 Logotherapy the human spirit and “the meaning of human exis- or the past. Paul T. P. Wong proposes that it may be tence as well as on man’s search for such a meaning.” more helpful for scientific and therapeutic purposes to What sets Frankl apart from North America’s existen- conceptualize the human spirit as inner resources, tial psychotherapy is his unconditional affirmation of which can come to one’s aid in with life stress. life’s meaning. The main objective of logotherapy was to facilitate clients’ quest for meaning and empower them to live meaningfully, responsibly, regardless of B. Logotherapy and their life circumstances. Frankl differentiates between spirit, , and Logotherapy was put to severe test in a very personal religion. Spirit refers to one of the dimensions of hu- way between 1942 and 1945, when Frankl was commit- manity. Spirituality is manifest in a person’s quest for ted to . His in meaning. Religion encompasses the ultimate meaning, these camps was recorded in his best-selling book Man’s super meaning, as well as . He clearly recognizes Search for Meaning. His personal triumph over unimag- the importance of religion but is reluctant to be con- inable trauma has been the most compelling testimony sidered religious. He equates authentic religion with to logotherapy. There are no other psychotherapists deep spirituality. whose life and work are as inseperable as Frankl’s. He is In an interview with Matthew Scully in 1995, when logotherapy, and vice versa. Frankl was already 90, he seemed to be more explicit about the important role of religion and faith in lo- gotherapy. Frankl said: II. THE SPIRITUAL DIMENSION I have come to define religion as an expression, a It is not possible to practice logotherapy without un- manifestation, of not only man’s will to meaning, but of derstanding the human spirit or the spiritual dimension man’s longing for ultimate meaning, that is to say a of human existence. According to Frankl’s dimensional meaning that is so comprehensive that it is no longer ontology, human beings exist in three dimensions— comprehensible … But it becomes a matter of believing somatic, mental, and spiritual. Spirituality is the uniquely rather than thinking, of faith rather than intellect. The human dimension. However, these different dimensions positing of a super-meaning that evades mere rational grasp is one of the main tenets of logotherapy, after all. must be understood in their totality because a person is a And a religious person may identify Supermeaning as unity in complexity. something paralleling a Superbeing, and this Superbe- ing we would call God. A. The Defiant Power of the Human Spirit One of the prepositions of logotherapy is that the III. THE MEANING OF MEANING human spirit is our healthy core. The human spirit may be blocked by biological or psychological sickness, but it The Greek word logos represents the word, the will of will remain intact. The human spirit does not get sick, God, the controlling principles of the universe, or even when the psychobiological organism is injured. meaning. Dr. Frankl translates logos as meaning. There- According to Frankl, part of the human spirit is un- fore, logotherapy means healing and health through conscious. When the human spirit is blocked or re- meaning. But what is meaning? pressed, one existential vacuum or neurosis. Existential analysis seeks to remove the block A. Specific versus Ultimate Meaning and brings to consciousness the will to meaning. According to Joseph Fabry, the noetic dimension of According to Frankl, there are two levels of meaning: the human spirit is the “ chest” of logother- (a) the present meaning, or meaning of the moment, apy; it contains love, the will to meaning, purpose, cre- and (b) the ultimate meaning or super-meaning. Dr. ativity, , the capacity for choice, Frankl believes that it is more productive to address responsibility, sense of humor, and so forth. specific meaning of the moment, of the situation, The defiant power of the human spirit refers to peo- rather than talking about meaning of life in general, be- ple’s capacity to tap into the spiritual part of the self cause ultimate meanings exist in the supra-human and rise about the negative effects of situations, illness dimension, which is “hidden” from us. He cautions Logotherapy 109 against addressing ultimate meanings in therapy, unless A. Freedom of Will the client is openly religious. Frankl realizes that “Human freedom is finite free- Each individual must discover the specific meanings dom. Man is not free from conditions. But he is free to of the moment. Only the individual knows the right take a stand in regard to them. The conditions do not meaning specific to the moment. The therapist can also completely condition .” Although our existence is facilitate the quest and guide the client to those areas in influenced by , inherited disposition, and en- which meanings can be found. vironment, an area of freedom is always available to us. “Everything can be taken from a man, but … the B. Meaning versus Value last of the human freedoms—to choose one’s attitude In his earlier writings, Frankl often used meaning in any a given set of circumstances, to choose one’s and value interchangeable. Fabry has clarified the dif- own way.” Therefore, we always have the freedom to ference between meaning and value: take a stand toward the restrictive conditions and transcend our fate. We create unique relationships and accept unique Freedom of will is possible because of the human ca- tasks, face unique sufferings, experience unique pacity for self-distancing or self-detachment: “By virtue and die a unique death. The search for mean- of this capacity man is capable of detaching himself not ing is highly personal and distinct. But millions of peo- only from a situation, but also from himself. He is capa- ple have gone through situations that were similar enough so they could react in a similar way. They ble of choosing his attitude toward himself.” found what was meaningful in standard situations. They found universal meanings, which is the way B. Responsibility Frankl defines values: “meaning universals.” and Responsibleness Therefore, values are abstract meanings based on the With freedom comes responsibility. Joseph Fabry meaning experiences of many, many individuals. Frankl once said responsibility without freedom is tyranny, believes that these values can guide our search for mean- and freedom without responsibility leads to anarchy, ing and simplify decision making. For example, life can which can lead to “boredom, anxiety, and neurosis.” be made meaningful if we realize three categories of val- Frankl points out that we are responsible not only to ues—experiential, creative and attitudinal. something but also to Someone, not only to the task, Traditional values are the examples of the accumula- but to the Taskmaster. tion of meaning experiences of many individuals over a Frankl differentiatess between responsibility and re- long period of time. However, these values are threat- sponsibleness. The former comes from possessing the ened by modernization. Frankl believes that “Even if all freedom of will. The later refers to exercising our free- universal values disappeared, life would remain mean- dom to make the right decisions in meeting the de- ingful, since the unique meanings remain untouched by mands of each situation. “Existential analysis aims at the loss of traditions.” nothing more and nothing less than leading men to Implicit in all his writings, Frankl gives the impres- consciousness of their responsibility.” sion that values, like Kant’s categorical imperatives, are somehow universal, from which specific meanings C. Will to Meaning flow. Thus, every experience of meaning involves the Frankl considers the will to meaning as “the basic realization of some values. But these values may lie la- striving of man to find and meaning and purpose.” The tent and need to be awakened or cultivated through ex- will to meaning is possible because of the human ca- istential analysis. This kind of reasoning may explain pacity to transcend immediate circumstances. “Being why Frankl insists: “The meaning of our existence is human is being always directed, and pointing to, some- not invented by ourselves, but rather detected.” thing or someone other than oneself: to a meaning to fulfil or another human being to encounter, a cause to IV. BASIC TENETS serve or a person to love.” Self-transcendence often makes use of the power of The logotherapeutic credo consists of freedom of will, imagination and optimism. Self-transcendence is es- will to meaning, and the meaning of life. These are the sential for finding , which is not the end, but cornerstones of logotherapy and existential analysis. the by-product of trying to forget oneself. “Only to the 110 Logotherapy extent to which man fulfils a meaning out there in the observed that people are willing to endure any suffering, world, does he fulfil himself.” if they are convinced that this suffering has meaning. However, suffering without meaning leads to despair. D. Meaning of Life Logotherapists do not ask for the for suffer- ing, but guide their clients toward the realization of Every meaning is unique to each person, and each concrete meanings, and choose the right attitudes. one has to individually discover the meaning of each Often, logotherapists appeal to their clients to take a particular situation. The therapist can only challenge heroic stand toward suffering, by suggesting that un- and guide the patient to potential areas of meaning: avoidable suffering gives them the opportunity to bear creative, experiential, and attitudinal values. witness to the human potential and dignity. According to logotherapy, we can discover this mean- Search for meaning is more likely to be occasioned ing in life in three different ways: (1) by creating a work by three negative facets of human existence: pain, guilt, or doing a deed; (2) by experiencing something or en- and death. Pain refers to human suffering, guilt to the countering someone; and (3) by the attitude we take to- awareness of our fallibility, and death to our awareness ward unavoidable suffering. of the transitoriness of life. These negative experiences Attitudinal values are especially important in situa- make us more aware of our needs for meaning and spir- tions of unavoidable suffering. Frankl claims: “This is itual aspiration. Neuroses are more likely to originate why life never ceases to hold meaning, for even a per- from our attempt to obscure the reality of pain, guilt, son who is deprived of both creative and experiential and death as existential facts. Logotherapy provides an values is still challenged by a meaning to fulfil, that is, answer to the through attitudinal values by the meaning inherent in the right, in an upright way and tragic optimism. of suffering.”

VI. LOGOTHERAPEUTIC V. EXISTENTIAL FRUSTRATION TECHNIQUES AND APPLICATIONS AND Frankl considers noogenic neurosis as the collective Existential frustration is a universal human experience neurosis of contemporary Western . The goal of because the will to meaning can be blocked by external logotherapy is to enable patients to discover their circumstances and internal hindrances. Existential frus- unique meanings and consider their own areas of free- tration leads to noogenic neurosis or existential vacuum. dom. In cases of psychogenic or individual neurosis, According to Frankl, “Noogenic neuroses have their ori- which may be treated by traditional psychotherapy or gin not in the psychological but rather in the ‘noological’ medication, logotherapy serves as a supplement and (from the Greek noos meaning ) dimension of helps break the vicious cycles of neurosis. human existence.” Therefore, logotherapy is uniquely According to E. Lukas, the four main logotherapeu- appropriate in dealing with existential neuroses. tic techniques are paradoxical intention, dereflection, Existential vacuum refers to general sense of meaning- modification of attitudes, and appealing techniques. lessness or emptiness, as evidenced by a state of bore- dom. It is a widespread phenomenon of the twentieth A. Paradoxical Intention century, as a result of industrialization, the loss of tradi- tional values, and dehumanization of individuals. People Frankl defines paradoxical intention as follows: “The may experience existential vacuum without developing patient is encouraged to do, or to wish to happen, the existential neurosis. Many feel that life has no purpose, very things he fears (the former applying to the phobic no challenge, no obligation, and they try to fill their exis- patient, the latter to the obsessive-compulsive).” tential vacuum with materials things, pleasure, sex, or This technique builds on the human capacity for power, busy work, but they are misguided. Frankl self-detachment to break the vicious cycle, which traps believes that “The of meaninglessness not only people in psychogenic neuroses, such as phobia, anxi- underlies the mass neurotic triad of today, i.e., depres- ety, and obsessive—compulsive behaviour. Self-attach- sion--, but also may eventuate in ment enables to patient to adopt a new attitude, to what we logotherapists call a ‘noogenic neurosis.’” stand back or laugh at the situation or self. In applying Suffering is not a necessary condition for meaning, paradoxical intention, the therapist tries “to mobilize but it tends to trigger the quest for meaning. Frankl has and utilize exclusive human capacity for humor.” Logotherapy 111

For the phobic patient, he has a “fearful expectation” of the human spirit to transcend their present condi- that a particular symptom might occur, and his fear cre- tions and move toward positive activities. This will re- ates “anticipatory anxiety, which in turn brings about sult in a reduction of symptom. what the patient fears to happen. Thus “fear of fear” Joseph Fabry points out that by immersing ourselves creates a “vicious cycle.” The most common reaction to in work or by choosing the right attitude, we can tran- “fear of fear” is “flight from fear,” and the phobic pat- scend not only external conditions but also ourselves. tern is maintained by excessive avoidance. This vicious The goal of dereflection is to help clients transcend them- cycle is broken when “the pathogenic fear is replaced selves and move toward creative and experiential values. by a paradoxical wish.” As a result, the patient no longer avoids situations that create anxiety. C. Modification of Attitudes With phobic patient, paradoxical intention typically begins with self-detachment (often after invitation and It is used for noogenic neuroses, depression, and ad- persuasion). The second step is to ask the patient to de- diction by promoting the will to meaning. It can also velop a new attitude of not fearing but welcoming the be used in coping with suffering related to circum- symptoms. This typically results in a reduction of stances, fate or illness. Generally, the emphasis is on symptom, which allows therapist to work toward en- reframing attitudes from negative to positive. For ex- hancing meaningful living. ample, the client may be asked: “Is there anything pos- In the case of obsessive–compulsive disorder, the pa- itive about the situation?” or “What freedom is still tient fights against the obsessions or compulsions. available to you in this situation?” However, the more he fights against these symptoms, the stronger they become. Again, a vicious cycle is cre- D. The Appealing Technique ated. To break this vicious cycle, the patient with com- pulsive hand washing because of fear of infection These three logotherapeutic techniques are more would be told to tell himself “I can’t get enough bacte- likely to be effective, when the therapist appeals to the ria, I want to become as dirty as possible.” client’s defiant power of the human spirit. The therapist According to D. Guttmann, paradoxical intention makes use of the power of and directly ap- has been used with increasing frequency with good re- peals to the client to change for the better, regardless of sults especially in treating clients who suffer from pho- the client’s current circumstances, and physical–emo- bias and obsessive–compulsive disorder. tional condition. The therapist expresses trust in the client’s dignity, freedom, responsibility, meaning orien- tation, and potential for positive change. B. Dereflection Frankl claims that “Logotherapy is neither teaching Frankl developed dereflection to counteract hyper- nor preaching. It is far removed from logical reasoning intention (trying too hard) and hyperreflection as it is from moral exhortation.” However, appealing (thinking too hard). Examples of hyperintention in- often involves exhortation on the value of taking a clude trying very hard to fall asleep, excessively pur- heroic stand against suffering. For example, a nurse suing pleasure, happiness, or power. Addiction is a suffered from an inoperable tumor and experienced form of hyperintention. despair because of her incapacity to work. Frankl tried Hyperreflection involves excessively monitoring to appeal to her sense of pride and moral obligation to one’s performance, and becoming very anxious about her patients: failure. Hyperreflection may turn everyday minor prob- lem into catastrophes, and small obstacles into insur- I tried to explain to her that to work eight or ten mountable hurdles. hours per day is no great thing—many people can do This technique is built on the human capacity of self- that But to be as eager to work as, and so incapable of distancing and self-transcendence. The clients are work, and yet not be despair—that would be as asked to redirect their attention away from their prob- achievement few could attain. And then I asked her: “Are you not being unfair to all those sick people to lems to more positive aspects of their lives. For exam- whom you have dedicated your life; are you not being ple, instead of worrying about not being able to fall unfair to act now as if the life of an invalid were with- asleep, the client is asked to use the time to read a book out meaning? If you behave as if the meaning of our or watch TV. Typically, the first step is to help clients to life consisted in being able to work so many hours a put some distance between themselves and their symp- day, you take away from all sick people the right to live toms. Then, they are invited to use their defiant power and the justification for their existence. 112 Logotherapy

E. The Socratic Dialogue Langle has applied existential analysis to cases of psy- chosocial, psychosomatic, and psychogenic disturbances. In Socratic dialogue, the therapist facilitates the Langle recognizes four fundamental preconditions client’s discovery of meaning, freedom, and responsibil- for meaningful existence: (a) accept the situation, (b) ity by challenging and questioning. The dialogue may find some positive value in the situation, (c) respond begin with a struggle between client and therapist but according to one’s own conscience, and (d) recognize should never become negative. the specific demands of the situation. According to Paul Welter: “Socratic questions need to He also postulates four types of fundamental human be asked that stretch the thinking of the client. This re- : quires careful listening to find the circumference of the client’s .” Another consideration is that counsel- 1. The question of existence: I am, but can I become a lors need to know the moment when silence is more cur- “whole” person? Do I have the necessary space, ative. Often silence occurs when the clients reflect on the support, and protection? deeper meanings of words from the counsellors. 2. The question of life: I am alive, but do I enjoy it? Do I find it fulfilling? Do I experience a sense of F. Logotherapy abundance, love, and realization of values? 3. The question of the person: I am myself, but am I J. Lantz has applied logotherapy to help the client free to be myself? Do I experience validation, re- family discover the meaning of opportunities within spect, and recognization of my own worth? the family through social skills training, Socratic ques- 4. The question of existential meaning: I am here, but tioning, and existential reflection. According to E. for what purpose, for what good? Lukas, meaning-centered helps the fam- ily focus on meaningful goals rather than the obstacles; Langle has developed additional methods, such as consequently, family members learn to overcome the the biographical method of using phenomenological obstacles to pursue meaningful goals. analysis to overcome unresolved past issues and the project analysis to elucidate areas that have proved to be a hindrance to one’s life. G. The Therapist–Client Joseph Fabry was largely responsible for introducing Relationship in Logotherapy logotherapy to North America. Under his guidance and Frankl tends to emphasize partnership between thera- encouragement, Paul T. P. Wong has developed the in- pist and client in the quest for meaning. According to tegrative meaning-centred conselling and therapy Lantz, logotherapeutic practice is based on the following (MCCT). It focuses on both the transformation of cog- assumptions: (a) commitment to authentic communica- nitive meanings as well as the discovery of new pur- tion by the therapist, (b) the therapists’ communication poses in life. As an integrative , it of essential humanness, and c) the therapist’s ultimate incorporates cognitive-behavioral interventions and concern being similar to that of the clients. with logotherapy.

See Also the Following Articles VII. RECENT DEVELOPMENTS Alderian Psychotherapy Biblical Behavior Modification In the past 15 years, Dr. Frankl’s classic logotherapy Existential Psychotherapy Humanistic Psychotherapy Paradoxical Intention has been elaborated and extended by Alfried Langle and the International of Logotherapy and Existential Analysis (Gesellschaft fur Logotherapie und Further Reading Existenzanalyse). This Viennese society (GLE-Wien) is Fabry, J. (1994). The pursuit of meaning (new rev. ed.). Abi- parallel to Viktor-Frankl-Institut–Scientific Society for lene, TX: Institute of Logotherapy Press. Logothrapy and Existential Analysis (Wissenschaftliche Frankl, V. E. (1984). Man’s search for meaning (rev. and up- fur Logotherapie und Existenzanalyse), also in . dated). New York: Washington Square Press/Pocket Books. According to A. Langle, existential analysis is now a Frankl, V. E. (1986). : From psy- full-fledged psychotherapeutic method, of which Dr. chotherapy to logotherapy (Rev. and expanded). New York: Frankl’s logotherapy is considered its subsidiary branch. Vintage Books. Logotherapy 113

Guttmann, D. (1996). Logotherapy for the helping professional: Lukas, E. (1984). Meaningful living. New York: Grove Press. Meaningful . New York: Springer. Lukas, E. (1991). Meaning-centered family therapy. The Inter- Langle, A. (2000). Existential analysis. Ubersetzung von national Forum for Logotherapy, 14, 67–74. 1999 Fundamenta Psychiatrica: EA – die Zustimmung Welter, P. (1987). Counseling and the search for meaning. zum Leben finden. Waco, TX: Word Books. Lantz, J. (1996). Stages and treatment activities in family lo- Wong, P. T. P. (1999). Towards an integrative model of mean- gotherapy. The International Forum for Logotherapy, 19, ing-centered counselling and therapy. The International 20–22. Forum for Logotherapy, 22, 47–55.