1.What is Logotherapy? a) Definition Literally, logotherapy means 'therapy through meaning'.

It's an active-directive therapy aimed at helping people specifically with meaning crises, which manifest themselves either ina feeling of aimlessness or indirectly through addiction, alcoholism or depression. Logotherapy also employs techniques useful for phobias, anxiety, obsessive-compulsive disorders and medical ministry. Other applications include working with juvenile delinquents, career counselling and helping all of us find more meaning in life. b) Foundations i) Existentialism It's existentialist becauseit emphasises the freedom of the will and the consequent responsibility.It also, of course, asserts the importance of the meaning of life. Whilst Freud said human's have a will to pleasure and Adler the will to power, Frankl says we have a will to meaning. If it is frustrated, spiritual (noogenic) neuroses result. Frankl argued that the the spiritual (noetic) dimension of man should be added to the physical and psychological dimensions. For Frankl, ultimate meaning does exist andis unique to each person and each situation. Each moment offers 'a sequence of unrepeatable situations each of which offers a specific meaning to be recognised and fulfilled'. Meaning cannot be invented but must be discovered. ii) Stoicism It's Stoic, because it holds that no matter what the state of the world, our attitude can always help us. The Stoic Epictetus held that 'Men are not moved by events but by their interpretations'. Even in facing death and suffering, by showing courage we can turn a situation into a supremely meaningful one. iii) Frankl's own experiences, in concentration camps and as a psychiatrist "This was the lesson I had to learn in three years spent in Auschwitz and Dachau: other things being equal, those apt to survive the camps were those oriented toward the future - toward a task, or a person, waiting for them in the future, toward a meaning to be fulfilled by them in the future" . But Logotherapy was also the result of Frankl's own ideas and improvisations, not all of which are very obviously connected with his experiences in the camps or the meaning of life. 2.Techniques of Logotherapy Paradoxical Intention The therapist encourages the patient to intend or wish for, even if only for a second, precisely what they fear. oUsed for obsessive, compulsive and phobic conditions (not for suicidal or schizophrenic patients). oUseful in cases of underlying anticipatory anxiety, often works very quickly. oMobilises the human capacity for self-detachment, often with a sense of humour oHans Gerz claims that paradoxical intention is successful in 80-90% of cases The case of the sweating doctor (from Pyschotherapy and Existentialism, p 139) A young doctor had severe hydrophobia. One day, meeting his chief on the street, as he extended his hand in greeting, he noticed that he was perspiring more than usual. The next time he was in a similar situation he expected to perspire again, and this anticipatory anxiety precipitated excessive sweating. It was a vicious circle We advised our patient, in the event that his anticipatory anxiety should recur, to resolve deliberately to show the people whom he confronted at the time just how much he could really sweat.A week later he returned to report that whenever he met anyone who triggered his anxiety, he said to himself, "I only sweated out a litre before, but now I'm going to pour out at least ten litres !" What was the result of this paradoxical resolution ? After suffering from his phobia for four years, he was quickly able, after only one session, to free himself of it for good. You are the logotherapist In the following cases, what paradoxical intention, if any, would you recommend ? i)A man is fearful that he will die from a heart attack. Physical check-ups reveal him to be in good health. ii) An obsessive-compulsive comes to you because she is concerned about the number of times she washes her hands each day. iii) A young man comes to you for help with stuttering. What do you advice ? iv) A schizophrenic is anxious that the people he sees on the tube are out to get him. Dereflection

The therapist diverts the patients away from their problems towards something else meaningful in the world. oused specifically for sexual dysfunction. Deflection indicated because (e.g.) the more you think about potency during sex, the less likely you are to achieve it, oNo use just telling them to stop thinking about something need to substitute something positive ( e.g. insomniac -dont just tell them to stop trying to sleep, tell them to count sheep). oMore generally, logotherapy can be seen as dereflecting the patient away from their presenting problem towards searching for meaning. Patient is dereflected from their disturbance to something other than themselves. Frankl's advice to Anna, 19-year old art student who displays severe symptoms of incipient schizophrenia. She considers herself as being confused and asks for help. Patient What is going on within me ? Frankl: Don't brood over yourself. Don't inquire into the source of your trouble. Leave this to us doctors. We will steer and pilot you through the crisis. Well, isn't there a goal beckoning you say, an artistic assignment ? Patient: But this inner turmoil . Frankl: Don't watch your inner turmoil, but turn your gaze to what is waiting for you. What counts is not what lurks in the depths, but what waits in the future, waits to be actualised by you. Patient: But what is the origin of my trouble ? Frankl: Don't focus on questions like this. Whatever the pathological process underlying your psychological affliction may be, we will cure you. Therefore, don't be concerned with the strange feelings haunting you. Ignore them util we make you get rid of them. Don't watch them. Don't fight them. Imagine, there are about a dozen great things, works which wait to be created by Anna, and there isno one who could achieve and accomplish it but Anna. No one could replace here in this assignment, They will be your creations, and if you don't create them, they will remain uncreated forever Patient : Doctor, I believe in what you say. It is a message which makes me happy. Orientation towards Meaning The therapist tries to enlarge the patient's discernment of meaning in the past, present and future, and creatively, experientially and attitudinally. 1. Meaning through creative values Frankl says that "The logotherapist's role consists in widening and broadening the visual field of the patient so that the whole spectrum of meaning and values becomes conscious and visible to him". A major source of meaning is through the value of all that we create, achieve and accomplish. " 2. Meaning through experiential values Frankl (The Doctor and the Soul) writes "Let us ask a mountain-climber who has beheld the alpine sunset and is so moved by the splendour of nature that he feels cold shudders running down his spine - let us ask him whether after such an experience his life can ever again seem wholly meaningless". 3. Meaning throughattitudinal values Frankl argued that we always have the freedom to find meaning through meaningful attitudes even in apparently meaningless situations. For example, an elderly, depressed patientwho could not overcome the loss of his wife was helped by the following conversation with Frankl. Frankl asked "What would have happened if you had died first, and your wife would have had to survive you". "Oh," replied the patient, "for her this would have been terrible; how she would have suffered ! Frankl continued "You see such a suffering has been spared her; and it is you who have spared her this suffering; but now, you have to pay for it by surviving her and mourning her."The mansaid no word, but shook Frankl's hand and calmly left his office." (Man's Search for Meaning) Case study of Harold (Chris Wurm) Harold was a middle-aged Australian whose life was rapidly spiralling out of control As well as a drinking problem he had financial problems- not helped by the amount he spent on drink - and was under considerable stress at work. His wife's sympathy was running out - no wonder he was also having trouble sleeping at night. He went to seeChris Wurm,a GP as well as a logotherapist. Wurm combined a medical approach - for example giving information about the damage drink was doing - with logotherapy. Invery fewsessions Harold's life was turned round, partly by the clarification the role of alcohol in his life and the

alternatives. Wurm says"It was possible to discuss the notion that he could make choices and live his life in a variety of ways " ( there we see logotherapy's emphasis on responsibility) " some of which would be more meaningful than others. He was then able to reflect on the choices he had been making (this is the orientation towards meaning and values) , and the possibilities available in the future". "It was dramatic to see how determinedand effective he became, once he saw how his old strategies were backfiring".

3.Assessing Logotherapy a) Strengths Inspiration of Viktor Frankl's life Relatively simple to understand, potentially life-changing and enhancing Addresses dimension of life not addressed by other therapies Optimistic and constructive b) Limitations Too authoritarian ? Too religious and not sufficiently scientific or rigorous? Too dependent on Frankl and his intuitions ? Too narrow ?

4.Developments in Logotherapy i) Attempts to focus on values and meanings more systematically. James Crumbaugh, co-inventor of the Purpose in Life test, has devised a number of exercises he gives to clients to help orientate them towards meaning and values. (see separate handout). The idea is also to work out the underlying values and how you might fulfil them, in order to lead a more meaningful life. Crumbaugh has also devised 6 lists that are used throughout analysis. 1. Life-long aims, ambitions, goals and interests going back as far as the client can remember, including those s/he no longer considers important. 2. The strong points of personality, physical and environmental circumstances, "good luck". 3. The weak points of personality, failures, "bad luck". 4. Specific problems that cause the client's conflicts. 5. Future hopes (this list may overlap with the first list above but emphasises the future whilst list 1 includes past ambitions). 6. Future plans, immediate and long-range. In my own work, I have incorporated these into a broader framework (called RSVP) which not only tries to find things that might be meaningful and valuable put also tries to establish whether they really are ii)Attempts to put logotherapy on a more scientific footing Wong & Fry'sThe Human Quest for Meaning (1998) represents an attempt by a number of psychologists to create a more testable, rigorous and up-to-date meaning-centred therapy.One advance is work on the Life Regards Index to improve on the old Purpose in Life Test, in order to determine which patients are good candidates for logotherapy and to measure their improvement.

Page 1 INTRODUCTION TO VIKTOR FRANKL'S LOGOTHERAPY

VIKTOR E. , MD, PhD (1905-1997) A professor of both psychiatry and philosophy at the University of Vienna, Austria, Dr. Frankl was the founder of logotherapy. His logotherapy looks at our lives in a different way than most other psychotherapeutic theories. It looks to the healthy spiritual core of man for resources of healing, instead of analyzing pathology ad infinitum. Definition of the term logotherapy: therapy through finding meaning (logos= meaning). [The Greek term logos will be familiar to students of theology. It is usually translated as the "Word" or "Will" of God in religious circles. In a broader sense, it can be viewed as "that which gives reason for being." Frankl prefers the simple translation of logos as "meaning."] Basic assumptions of logotherapy: 1. Life has meaning under all circumstances. 2. People have a will to meaning. 3. People have freedom under all circumstances to activate the will to meaning and to find meaning. Dimensional ontology image of man The human being is an entity consisting of: 1. Body (soma) 2. Mind (psyche) 3. Spirit (noetic core) This is an image of man, where the scientific and the philosophic views are combined. Frankl was a clinician as well as a philosopher! Although we can experience sickness in the body and the psyche, the human spirit, our noetic core, remains healthy; however, access to that healthy core can be blocked.

Page 2 Attributes of the noetic dimension: 1. Responsibility (not from, but responsibility to) 2. Authenticity and creativity 3. Choices

4. Values 5. Self-transcendence 6. Will to meaning 7. Love 8. Conscience 9. Ideals and ideas, etc.... How can we find meaning in life? Frankl points to three ways the "meaning triangle:" 1. Creativity (giving something to the world through self-expression: using our talents in various ways; i.e., the work we do, the gifts we give to life). 2. Experiencing (receiving from the world: through nature, culture, relationships, interactions with others and with our environment). 3. Change of attitude (even if we can't change a situation or circumstance, we can still choose our attitude toward a condition; this is often a self-transcending way of finding meaning, especially in unavoidable suffering). The two levels of meaning in life Viktor Frankl talks of two different meanings: 1. Ultimate meaning: A meaning we can never reach but just glimpse at the horizon... It can be God, but also science as the search for truth, nature, and evolution for those who do not believe in God. 2. Meaning of the moment: We have all the time to answer the questions life asks us and, therefore, it is important to understand the meaning of each moment by fulfilling the demands life places on us.

Page 3 The demand quality of life Logotherapy teaches that it is not we who can ask life, "WHY, WHY, WHY...?" Rather, it is Life, who is the questioner. We have to respond to Life's questions! We answer to Life by listening for discernment of the meaning of the moment; then, by making responsible decisions within our available area of freedom. Our choices will be based on our values and guidance received from the voice of our conscience. The lack of meaning in life results in an existential vacuum When life has no meaning, it becomes empty. We live in what Frankl calls an "existential vacuum." It is a state of inertia, boredom, and apathy experienced by many. If this state persists, it progresses into existential frustration, and eventually becomes a "noogenic neurosis." We try to fill the existential vacuum with drugs, violence, also with food, over-work, sports, etc., yet remain unfulfilled. Noogenic neurosis This state is what the DSM-IV refers to as "somatization disorder". In about 20% of these cases, the maintaining cause of somatization disorder lies in the noetic level, not in the psycho-physical. Noogenic neurosis can be the result of protracted existential vacuum or a conflict of values that result in conflicts in conscience. The tragic triad Since life is dynamic, we are faced all the time with elements of the tragic triad:

1. Unavoidable suffering 2. Guilt 3. Death Here, usually the best way to find a meaning -- especially in a situation we cannot change -- is to change our attitude! A new meaning will often dawn by doing so.

Page 4 Helping people to find meaning We are spirit. Our healthy core lies in the noetic dimension, therefore, the medicine chest of logotherapy is to be found in the noetic dimension. There, the "defiant power of the human spirit" has to be activated and brought to bear on current life situations to bring about the desired change that is healing or life-giving. With the awareness that we are spirit, we recognize that what we have can be taken from us, but who we are, never! We are unique. There are always situations where we experience our uniqueness: in relationships, in creativity, etc, etc.... Maybe the painting we made is not a masterpiece, but it is ours! We practice self-transcendence. It is through transcending our previous limitations, striving toward a worthwhile goal, encountering other human beings that we find meaning and fulfillment in our lives. We can change our attitude. When faced with unavoidable suffering, we can often find meaning in the situation by looking at it in a different way; i.e., by courageously bearing what cannot be changed. The tools of logotherapy The main tool is the Socratic dialogue where the therapist and the client together try to find a meaning in life. Meaning cannot be given, it must be discovered. 1. The first thing is to make the client realize that he is NOT A VICTIM of circumstances! He might have symptoms, but he IS NOT his symptoms. 2. Try to help client find a meaning within his "meaning triangle." 3. Make client independent of the therapist by helping him find his guidance within.

Page 5 Conclusion

Logotherapy is Viktor Frankl's philosophy of life. As such, it can be used in every profession and walk of life. Today it is being used by educators, counselors, ministers, business managers, etc. We can all use it in our daily life, when dealing with our family, friends or colleagues! Accepting that our life (where we stand today) is a consequence of our choices made in the past, our future will consequently be shaped by the choices we make today! Every day we have many possibilities from which to choose within our area of freedom. We must choose the most responsible option; make the best choice, not only for ourselves, but also the people around us then happiness and meaning fulfillment will ensue. Irmeli Sjlie Diplomate in Logotherapy, Vancouver, October 2, 2002