Logotherapy
Logotherapy was developed by neurologist and psychiatrist Viktor Frankl[1] and is based on the premise that the primary motivational force of an individual is to find a meaning in life.[2] Frankl describes it as "the Third Viennese School of Psychotherapy"[3][4] along with Freud's psychoanalysis and Adler's individual psychology.[5]
Logotherapy is based on an existential analysis[6] focusing on Kierkegaard's will to meaning as opposed to Alfred Adler's Nietzschean doctrine of will to power or Freud's will to pleasure. Rather than power or pleasure, logotherapy is founded upon the belief that striving to find meaning in life is the primary, most powerful motivating and driving force in humans.[2] A short introduction to this system is given in Frankl's most famous book, Man's Search for Meaning (1946), in which he outlines how his theories helped him to survive his Holocaust experience and how that experience further developed and reinforced his theories. Presently, there are a number of logotherapy institutes around the world.
Philosophical basis of logotherapy[edit]
Frankl described the meta-clinical implications of logotherapy in his book The Will to Meaning: Foundations and Applications of Logotherapy.[13] He believed that there is no psychotherapy apart from the theory of the individual. As an existential psychologist, he inherently disagreed with the “machine model” or “rat model”, as it undermines the human quality of humans. As a neurologist and psychiatrist, Frankl developed a unique view of determinism to coexist with the three basic pillars of logotherapy (the freedom of will). Though Frankl admitted that a person can never be free from every condition, such as, biological, sociological, or psychological determinants; based on his experience during his life in the Nazi concentration camps, he believed that a person is “capable of resisting and braving even the worst conditions”. In doing such, a person can detach from situations and themselves, choose an attitude about themselves, and determine their own determinants, thus shaping their own character and becoming responsible for themselves.[14]
Logotherapeutic views and treatment[edit]
Overcoming anxiety[edit]
By recognizing the purpose of our circumstances, one can master anxiety. Anecdotes about this use of logotherapy are given by New York Times writer Tim Sanders, who explained how he uses its concept to relieve the stress of fellow airline travelers by asking them the purpose of their journey. When he does this, no matter how miserable they are, their whole demeanor changes, and they remain happy throughout the flight.[15] Overall, Frankl believed that the anxious individual does not understand that their anxiety is the result of dealing with a sense of “unfulfilled responsibility” and ultimately a lack of meaning.[16]
Treatment of neurosis[edit]
Frankl cites two neurotic pathogens: hyper-intention, a forced intention toward some end which makes that end unattainable; and hyper-reflection, an excessive attention to oneself which stifles attempts to avoid the neurosis to which one thinks oneself predisposed. Frankl identified anticipatory anxiety, a fear of a given outcome which makes that outcome more likely. To relieve the anticipatory anxiety and treat the resulting neuroses, logotherapy offers paradoxical intention, wherein the patient intends to do the opposite of their hyper-intended goal.
A person, then, who fears (i.e. experiences anticipatory anxiety over) not getting a good night's sleep may try too hard (that is, hyper-intend) to fall asleep, and this would hinder their ability to do so. A logotherapist would recommend, then, that the person go to bed and intentionally try not to fall asleep. This would relieve the anticipatory anxiety which kept the person awake in the first place, thus allowing them to fall asleep in an acceptable amount of time.[3]
Depression[edit]
Viktor Frankl believed depression occurred at the psychological, physiological, and spiritual levels.[16] At the psychological level, he believed that feelings of inadequacy stem from undertaking tasks beyond our abilities. At the physiological level, he recognized a “vital low”, which he defined as a “diminishment of physical energy”.[16] Finally, Frankl believed that at the spiritual level, the depressed individual faces tension between who they actually are in relation to what they should be. Frankl refers to this as the gaping abyss.[12]: 202 [16] Finally Frankl suggests that if goals seem unreachable, an individual loses a sense of future and thus meaning, resulting in depression.[16] Thus logotherapy aims “to change the patient's attitude toward their disease as well as toward their life as a task”.[12]: 200
In order to overcome depressed feelings and thoughts, Frankl challenges individuals who suffer from depression to find meaning in their suffering.[17] Frankl frequently cites Nietzsche's words, "If we have our own why in life, we shall get along with almost any how".[18] Suffering and all the negative emotions that come with it are a normal part of the human experience and should even be expected. Edith Weisskopf-Joelson, a psychologist and follower of logotherapy, argues that "our current mental-hygiene philosophy stresses the idea that people ought to be happy, that unhappiness is a symptom of maladjustment. Such a value system might be responsible for the fact that the burden of unavoidable unhappiness is increased by unhappiness about being unhappy".[19]
Obsessive-compulsive disorder[edit]
Frankl believed that those with obsessive-compulsive disorder lack the sense of completion that most other individuals possess.[16] Instead of fighting the tendencies to repeat thoughts or actions, or focusing on changing the individual symptoms of the disease, the therapist should focus on “transform[ing] the neurotic's attitude toward their neurosis”.[12]: 185 Therefore, it is important to recognize that the patient is “not responsible for his obsessional ideas”, but that “he is certainly responsible for his attitude toward these ideas”.[12]: 188 Frankl suggested that it is important for the patient to recognize their inclinations toward perfection as fate, and therefore, must learn to accept some degrees of uncertainty.[16] Ultimately, following the premise of logotherapy, the patient must eventually ignore their obsessional thoughts and find meaning in their life despite such thoughts.[12]
Schizophrenia[edit]
Though logotherapy wasn't intended to deal with severe disorders, Frankl believed that logotherapy could benefit even those with schizophrenia.[16] He recognized the roots of schizophrenia in physiological dysfunction.[16] In this dysfunction, the person with schizophrenia “experiences himself as an object” rather than as a subject.[12]: 208 Frankl suggested that a person with schizophrenia could be helped by logotherapy by first being taught to ignore voices and to end persistent self-observation.[16] Then, during this same period, the person with schizophrenia must be led toward meaningful activity, as “even for the schizophrenic there remains that residue of freedom toward fate and toward the disease which man always possesses, no matter how ill he may be, in all situations and at every moment of life, to the very last”.[12]: 216
Terminally ill patients[edit]
In 1977, Terry Zuehlke and John Watkins conducted a study analyzing the effectiveness of logotherapy in treating terminally ill patients. The study's design used 20 male Veterans Administration volunteers who were randomly assigned to one of two possible treatments – (1) group that received 8 45-minute sessions over a 2-week period and (2) group used as control that received delayed treatment. Each group was tested on 5 scales – the MMPI K Scale, MMPI L Scale, Death Anxiety Scale, Brief Psychiatric Rating Scale, and the Purpose of Life Test. The results showed an overall significant difference between the control and treatment groups. While the univariate analyses showed that there were significant group differences in 3/5 of the dependent measures. These results confirm the idea that terminally ill patients can benefit from logotherapy in coping with death.[20]
Forms of treatment[edit]
Ecce Homo is a method used in logotherapy. It requires of the therapist to note the innate strengths that people have and how they have dealt with adversity and suffering in life; to ask the patient to consider how, despite everything a person may have gone through, they made the best of their suffering. The method is called "Ecce Homo", which is Latin for "Behold the Man", because the method involves beholding how other people have made the best of their adversity.[21]
Recent developments[edit]
Since the 1990s, the number of institutes providing education and training in logotherapy continues to increase worldwide.VFI / Institutes worldwide (E) Numerous logotherapeutic concepts have been integrated and applied in different fields, such as cognitive behavioral therapy,[31] acceptance and commitment therapy (ACT),[32] and burnout prevention.[33] The logotherapeutic concepts of noogenic neurosis and existential crisis were added to the ICD 11 under the name demoralisation crisis, i.e. a construct that features hopelessness, meaninglessness, and existential distress as first described by Frankl in the 1950s.[34][35] Logotherapy has also been associated with psychosomatic and physiological health benefits.[36][37][38][39][40][41] Besides Logotherapy, other meaning-centered psychotherapeutic approaches such as positive psychology and meaning therapy have emerged.[42][43] Paul Wong's meaning therapy attempts to translate logotherapy into psychological mechanisms, integrating cognitive behavioral therapy, positive psychotherapy and the positive psychology research on meaning.[44][45] Logotherapy is also being applied in the field of oncology[46][47] and palliative care (William Breitbart).[48] These recent developments introduce Viktor Frankl's logotherapy to a new generation and extend its impact to new areas of research.[49]