Logotherapy

Logotherapy was developed by neurologist and psychiatrist Viktor Frankl,[1] on a concept 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]

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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, 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.

Basic principles

The notion of Logotherapy was created with the Greek word logos ("reason"). Frankl's concept is based on the premise that the primary motivational force of an individual is to find a meaning in life. The following list of tenets represents basic principles of logotherapy:

  • Life has meaning under all circumstances, even the most miserable ones.
  • Our main motivation for living is our will to find meaning in life.
  • We have freedom to find meaning in what we do, and what we experience, or at least in the stance we take when faced with a situation of unchangeable suffering.[2]

The human spirit is referred to in several of the assumptions of logotherapy, but the use of the term spirit is not "spiritual" or "religious". In Frankl's view, the spirit is the will of the human being. The emphasis, therefore, is on the search for meaning, which is not necessarily the search for God or any other supernatural being.[2] Frankl also noted the barriers to humanity's quest for meaning in life. He warns against "...affluence, hedonism, [and] materialism..." in the search for meaning.[7]

Purpose in life and meaning in life constructs appeared in Frankl's logotherapy writings with relation to existential vacuum and will to meaning, as well as others who have theorized about and defined positive psychological functioning. Frankl observed that it may be psychologically damaging when a person's search for meaning is blocked. Positive life purpose and meaning was associated with strong religious beliefs, membership in groups, dedication to a cause, life values, and clear goals. Adult development and maturity theories include the purpose in life concept. Maturity emphasizes a clear comprehension of life's purpose, directedness, and intentionality which contributes to the feeling that life is meaningful.[8]

Frankl's ideas were operationalized by Crumbaugh and Maholick's Purpose in Life (PIL) test, which measures an individual's meaning and purpose in life.[8] With the test, investigators found that meaning in life mediated the relationships between religiosity and well-being;[9] uncontrollable stress and substance use; depression and self-derogation.[8][10] Crumbaugh found that the Seeking of Noetic Goals Test (SONG) is a complementary measure of the PIL. While the PIL measures the presence of meaning, the SONG measures orientation towards meaning. A low score in the PIL but a high score in the SONG, would predict a better outcome in the application of Logotherapy.[11]

Discovering meaning

According to Frankl, "We can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering" and that "everything can be taken from a man but one thing: the last of the human freedoms – to choose one's attitude in any given set of circumstances".[3] On the meaning of suffering, Frankl gives the following example:

"Once, an elderly general practitioner consulted me because of his severe depression. He could not overcome the loss of his wife who had died two years before and whom he had loved above all else. Now how could I help him? What should I tell him? I refrained from telling him anything, but instead confronted him with a question, "What would have happened, Doctor, if you had died first, and your wife would have had to survive without you?:" "Oh," he said, "for her this would have been terrible; how she would have suffered!" Whereupon I replied, "You see, Doctor, 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 and mourning her." He said no word but shook my hand and calmly left the office.[3]:178–179

Frankl emphasized that realizing the value of suffering is meaningful only when the first two creative possibilities are not available (for example, in a concentration camp) and only when such suffering is inevitable – he was not proposing that people suffer unnecessarily.[12]:115

Philosophical basis of logotherapy

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

Overcoming anxiety

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

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

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

Obsessive-compulsive disorder

Frankl believed that those suffering from 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

Though logotherapy wasn't intended to deal with severe disorders, Frankl believed that logotherapy could benefit even those suffering from 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

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.[17]

Forms of Treatment

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. Despite everything a person may have gone through, they made the best of their suffering! Hence, Ecce Homo - Behold the Man! [18]

Controversy
See also: Psychotherapy § General critiques

Authoritarianism

In 1969 Rollo May argued that logotherapy is, in essence, authoritarian. He suggested that Frankl's therapy presents a plain solution to all of life's problems, an assertion that would seem to undermine the complexity of human life itself. May contended that if a patient could not find their own meaning, Frankl would provide a goal for his patient. In effect, this would negate the patient's personal responsibility, thus “diminish[ing] the patient as a person”.[19] Frankl explicitly replied to May's arguments through a written dialogue, sparked by Rabbi Reuven Bulka’s article “Is Logotherapy Authoritarian?”.[20] Frankl responded that he combined the prescription of medication, if necessary, with logotherapy, to deal with the person's psychological and emotional reaction to the illness, and highlighted areas of freedom and responsibility, where the person is free to search and to find meaning.[21]

Religiousness

Critical views of the life of logotherapy's founder and his work assume that Frankl's religious background and experience of suffering guided his conception of meaning within the boundaries of the person[22] and therefore that logotherapy is founded on Viktor Frankl's worldview.[23]

Frankl openly spoke and wrote on religion and psychiatry, throughout his life, and specifically in his last book, Man’s Search for Ultimate Meaning (1997). He asserted that every person has a spiritual unconscious, independently of religious views or beliefs, yet Frankl's conception of the spiritual unconscious does not necessarily entail religiosity. In Frankl's words: “It is true, Logotherapy, deals with the Logos; it deals with Meaning. Specifically, I see Logotherapy in helping others to see meaning in life. But we cannot “give” meaning to the life of others. And if this is true of meaning per se, how much does it hold for Ultimate Meaning?”[24] The American Psychiatric Association awarded Viktor Frankl the 1985 Oskar Pfister Award (for important contributions to religion and psychiatry).[24]

Recent developments

Since the 1990s, the number of institutes providing education and training in logotherapy continues to increase worldwide. Numerous logotherapeutic concepts have been integrated and applied in different fields, such as cognitive behavioral therapy,[25] acceptance and commitment therapy (ACT),[26] and burnout prevention.[27] 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.[28][29] Logotherapy has also been associated with psychosomatic and physiological health benefits.[30][31][32][33][34][35] Besides Logotherapy, other meaning-centered psychotheraeutic approaches such as positive psychology and meaning therapy have emerged.[36][37] 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.[38][39] Logotherapy is also being applied in the field of oncology[40][41] and palliative care (William Breitbart).[42] These recent developments introduce Viktor Frankl's logotherapy to a new generation and extend its impact to new areas of research.[43]

Locations

A number of logotherapeutic institutes have opened up in various countries around the world and include:

Africa

  • Viktor Frankl Institute of Logotherapy South Africa[44]

Asia

  • The Viktor Frankl Center for Logotherapy in Israel[45]
  • Japan Logotherapist Association[46]

Australia

  • Viktor Frankl Institute Australia[47]

Europe

  • Viktor Frankl Zentrum Wien[48]
  • Viktor Frankl Institute of Ireland[49]
  • Logotherapy Institute of Finland[50]
  • Viktor Frankl Institute of Logotherapy - Prague, Czech Republic[51]

North America

  • Viktor Frankl Institute of Logotherapy - Abilene, Texas[52]
  • Arizona Institute of Logotherapy[53]
  • Canadian Institute of Logotherapy - Ottawa, Canada[54]
  • Sociedad Mexicana de Análisis Existencial y Logoterapia[55]

South America

  • Fundacion Argentina de Logoterapia - Buenos Aires[56]
  • Associação Brasileira de Logoterapia e Análise Existencial Frankliana (SOBRAL)[57]

Online

  • Viktor Frankl Institute - Vienna, Austria[58]
  • Viktor Frankl Institute of America[59]

See also

References
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  2. Maria Marshall; Edward Marshall (2012). Logotherapy Revisited: Review of the Tenets of Viktor E. Frankl's Logotherapy. Ottawa: Ottawa Institute of Logotherapy. ISBN 978-1-4781-9377-7. OCLC 1100192135. Retrieved 16 February 2020.
  3. Frankl, Viktor (1 June 2006). Man's Search for Meaning. Beacon Press. ISBN 978-0-8070-1427-1. Retrieved 8 May 2012.
  4. Gordon Allport, from the Preface to Man's Search for Meaning, p. xiv
  5. "Logotherapy: The benefits of finding meaning in life". Medical News Today. Retrieved 2018-09-17.
  6. "About". Viktor Frankl Institute Vienna. Retrieved 22 May 2012.
  7. "About Logotherapy". Viktor Frankl Institute of Logotherapy. Retrieved 22 May 2012.
  8. Adler, Nancy (November 1997). "Purpose in Life". Psychosocial workgroup. MacArthur Foundation. Retrieved 2011-11-03.
  9. Dufton, Brian (Spring 1986). "The association between religiosity and the Purpose-in-Life test: Does it reflect purpose or satisfaction?". Journal of Psychology and Theology. Biola University. 14 (1): 42–48. doi:10.1177/009164718601400105. S2CID 149288526.
  10. Harlow, Lisa L.; Newcomb, Michael D.; Bentler, P. M (Sep 1987). "Purpose in Life Test assessment using latent variable methods". British Journal of Clinical Psychology. 26 (3): 235–236. doi:10.1111/j.2044-8260.1987.tb01355.x. PMID 3664045.
  11. Crumbaugh, James C. (July 1977). "The seeking of noetic goals test (SONG): A complementary scale to the purpose in life test (PIL)". Journal of Clinical Psychology. Wiley. 33 (3): 900–907. doi:10.1002/1097-4679(197707)33:3<900::AID-JCLP2270330362>3.0.CO;2-8. PMID 893732.
  12. Frankl, Viktor (12 October 1986). The Doctor and the Soul: From Psychotherapy to Logotherapy. Random House Digital, Inc. ISBN 978-0-394-74317-2. Retrieved 17 May 2012.
  13. 1905-1997, Frankl, Viktor E. (Viktor Emil) (2014-06-24). The will to meaning : foundations and applications of logotherapy (Expanded ed.). New York, New York. ISBN 9781101664025. OCLC 934802526.CS1 maint: numeric names: authors list (link)
  14. Frankl, Viktor (1 September 1988). The Will to Meaning: Foundations and Applications of Logotherapy. Meridian. ISBN 978-0-452-01034-5. Retrieved 17 May 2012.
  15. Sanders, Tim (27 October 2008). "A Chatterer's Guide to Easing Anxiety". The New York Times.
  16. Boeree, C. George (2006). "Viktor Frankl". Shippensburg University.
  17. Zuehlke, T.E.; Watkins, J.T. (1977). "Psychotherapy with Terminally Ill Patients". Psychotherapy: Theory, Research & Practice. 14 (4): 403–410. doi:10.1037/h0087512.
  18. Frankl, Viktor E.. The Will to Meaning (p. 94). Penguin Publishing Group. Kindle Edition.
  19. Rollo May (1969). Existential psychology. Random House. p. 42. Retrieved 21 May 2012. (First Edition 1961)
  20. Bulka, Reuven P. (Fall 1978). "Is Logotherapy Authoritarian?". Journal of Humanistic Psychology. 18 (4): 45–54. doi:10.1177/002216787801800406. S2CID 220400019.
  21. Frankl, Viktor (Fall 1979). "Reply to Rollo May". Journal of Humanistic Psychology. 19 (4): 85–86. doi:10.1177/002216787901900410. S2CID 145012871.
  22. Pytell, T. (2006). "Transcending the Angel Beast: Viktor Frankl and Humanistic Psychology". Psychoanalytic Psychology. 23 (3): 490–503. doi:10.1037/0736-9735.23.3.490.
  23. Pytell, T. (2007). "Extreme Experience, Psychological Insight, and Holocaust Perception: Reflections on Bettelheim and Frankl". Psychoanalytic Psychology. 24 (4): 641–657. doi:10.1037/0736-9735.24.4.641.
  24. Frankl, Viktor (10 August 2000). Man's search for ultimate meaning. Perseus Pub. ISBN 978-0-7382-0354-6. Retrieved 10 May 2012.
  25. Ameli, Matti; Dattilio, Frank M. (2013). "Enhancing cognitive behavior therapy with logotherapy: Techniques for clinical practice". Psychotherapy. 50 (3): 387–391. doi:10.1037/a0033394. ISSN 1939-1536. PMID 24000857.
  26. Sharp, William G.; Wilson, Kelly G.; Schulenberg, Stefan E. (December 2004). "Use of Paradoxical Intention in the Context of Acceptance and Commitment Therapy". Psychological Reports. 95 (3): 946–948. doi:10.2466/pr0.95.3.946-948. ISSN 0033-2941. PMID 15666933. S2CID 27391991.
  27. Riethof, Norbert; Bob, Petr (2019-06-14). "Burnout Syndrome and Logotherapy: Logotherapy as Useful Conceptual Framework for Explanation and Prevention of Burnout". Frontiers in Psychiatry. 10: 382. doi:10.3389/fpsyt.2019.00382. ISSN 1664-0640. PMC 6587911. PMID 31258490.
  28. Kissane, David W.; Clarke, David M.; Street, Annette F. (March 2001). "Demoralization Syndrome — a Relevant Psychiatric Diagnosis for Palliative Care". Journal of Palliative Care. 17 (1): 12–21. doi:10.1177/082585970101700103. ISSN 0825-8597. PMID 11324179. S2CID 41423140.
  29. Clarke, David M.; Kissane, David W. (December 2002). "Demoralization: Its Phenomenology and Importance". Australian & New Zealand Journal of Psychiatry. 36 (6): 733–742. doi:10.1046/j.1440-1614.2002.01086.x. ISSN 0004-8674. PMID 12406115. S2CID 23248298.
  30. Cohen, Randy; Bavishi, Chirag; Rozanski, Alan (2016). "Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events". Psychosomatic Medicine. 78 (2): 122–133. doi:10.1097/psy.0000000000000274. ISSN 0033-3174. PMID 26630073. S2CID 24337711.
  31. Rodriguez, L. (January 1939). "Additions à la flore des Antilles françaises". Bulletin de la Société Botanique de France. 86 (2): 175–177. doi:10.1080/00378941.1939.10834168. ISSN 0037-8941.
  32. "Life expectancy at birth: women". doi:10.1787/530655752103. Cite journal requires |journal= (help)
  33. Koizumi, M. (2008). "Effect of having a sense of purpose in life on the risk of death from cardiovascular diseases". Journal of Epidemiology. 18 (5): 191–196. doi:10.2188/jea.JE2007388. PMC 4771589. PMID 18753736.
  34. Kim, Eric S.; Sun, Jennifer K.; Park, Nansook; Kubzansky, Laura D.; Peterson, Christopher (2012-02-23). "Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up". Journal of Behavioral Medicine. 36 (2): 124–133. doi:10.1007/s10865-012-9406-4. ISSN 0160-7715. PMID 22359156. S2CID 6273837.
  35. Yu, Lei; Boyle, Patricia A.; Wilson, Robert S.; Levine, Steven R.; Schneider, Julie A.; Bennett, David A. (2015). "Purpose in Life and Cerebral Infarcts in Community-Dwelling Older People". Stroke. 46 (4): 1071–1076. doi:10.1161/strokeaha.114.008010. ISSN 0039-2499. PMC 4461202. PMID 25791714.
  36. Wong, P. T. P. (1997). Meaning-centered counselling: A cognitive-behavioral approach to logotherapy. The International Forum for Logotherapy, 20(2), 85-94.
  37. Wong, P. T. P. (2012). From logotherapy to meaning-centered counseling and therapy. In P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications (2nd ed., pp. 619-647). New York, NY: Routledge.
  38. Wong, P. T. P. (2016). Integrative meaning therapy: From logotherapy to existential positive interventions. In P. Russo-Netzer, S. E. Schulenberg, & A. Batthyany (Eds.). To thrive, to cope, to understand: Meaning in positive and existential psychotherapy (pp. 0-0). New York, NY: Springer.
  39. Wong, P. T. P. (2014). Viktor Frankl’s meaning seeking model and positive psychology. In A. Batthyany & P. Russo-Netzer (Eds.), Meaning in existential and positive psychology (pp. 149-184). New York, NY: Springer.
  40. Breitbart, W. S. & Poppet, S. R. (2014). Meaning-centered group psychotherapy for patients with advanced cancer: A treatment manual. New York, NY: Oxford.
  41. Breitbart, W. S. & Poppet, S. R. (2014). Individual meaning-centered psychotherapy for patients with advanced cancer: A treatment manual. New York, NY: Oxford.
  42. Breitbart, William; Heller, Karen S. (2003). "Reframing Hope: Meaning-Centered Care for Patients Near the End of Life". Journal of Palliative Medicine. 6 (6): 979–988. doi:10.1089/109662103322654901. ISSN 1096-6218. PMID 14733692.
  43. Batthyany, A., & Russo-Netzer, P. (2014). Meaning in positive and existential psychology. New York, NY: Springer.
  44. Viktor Frankl Institute of Logotherapy South Africa
  45. The Viktor Frankl Center for Logotherapy in Israel
  46. Japan Logotherapist Association
  47. - Viktor Frankl Institute Australia
  48. Viktor Frankl Zentrum WIen
  49. Viktor Frankl Institute of Ireland
  50. Logotherapy Institute of Finland
  51. Viktor Frankl Institute of Logotherapy - Prague, Czech Republic
  52. Viktor Frankl Institute of Logotherapy - Abilene, Texas
  53. "Arizona Institute of Logotherapy". Archived from the original on 2017-10-24. Retrieved 2018-03-11.
  54. Canadian Institute of Logotherapy - Ottawa, Canada
  55. - Sociedad Mexicana de Análisis Existencial y Logoterapia
  56. - Fundacion Argentina de Logoterapia - Buenos Aires
  57. - Associação Brasileira de Logoterapia e Análise Existencial Frankliana, Sao Paulo
  58. Viktor Frankl Institute - Vienna, Austria
  59. Viktor Frankl Institute of America

Bibliography
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