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Logotherapy was developed by neurologist and psychiatrist Viktor Frankl. It is considered the "Third Viennese School of Psychotherapy" after Freud's psychoanalysis and Adler's individual psychology. Logotherapy is based on an existential analysis focusing on Kierkegaard's will to meaning as opposed to 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 it is the striving to find a meaning in one's life that is the primary, most powerful motivating and driving force in humans. 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.
The notion of Logotherapy was created with the Greek word logos ("meaning"). 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:
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. 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.
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.
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. With the test, investigators found that meaning in life mediated the relationships between religiosity and well-being; uncontrollable stress and substance use; depression and self-derogation. 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.
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". 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 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.: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.:115
Frankl described the metaclinical implications of logotherapy in his book The Will of Meaning: Foundations and Applications of Logotherapy. He believed that there is no psychotherapy apart from the theory of man. 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 man 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 man is “capable of resisting and braving even the worst conditions”. In doing such, man can detach from situations, himself, choose an attitude about himself, determine his own determinants, thus shaping his own character and becoming responsible for himself.
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. Overall, Frankl believed that the anxious individual does not understand that his anxiety is the result of dealing with a sense of “unfulfilled responsibility” and ultimately a lack of meaning.
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 his 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 his ability to do so. A logotherapist would recommend, then, that he go to bed and intentionally try not to fall asleep. This would relieve the anticipatory anxiety which kept him awake in the first place, thus allowing him to fall asleep in an acceptable amount of time.
Viktor Frankl believed depression occurred at the psychological, physiological, and spiritual levels. 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”. Finally, Frankl believed that at the spiritual level, the depressed man faces tension between who he actually is in relation to what he should be. Frankl refers to this as the gaping abyss.:202 Finally Frankl suggests that if goals seem unreachable, an individual loses a sense of future and thus meaning resulting in depression. Thus logotherapy aims “to change the patient’s attitude toward her disease as well as toward her life as a task”.:200
Frankl believed that those suffering from obsessive-compulsive disorder lack the sense of completion that most other individuals possess. 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 his neurosis”.: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”.:188 Frankl suggested that it is important for the patient to recognize his inclinations toward perfection as fate, and therefore, must learn to accept some degrees of uncertainty. Ultimately, following the premise of logotherapy, the patient must eventually ignore his obsessional thoughts and find meaning in his life despite such thoughts.
Though logotherapy wasn’t intended to deal with severe disorders, Frankl believed that logotherapy could benefit even those suffering from schizophrenia. He recognized the roots of schizophrenia in physiological dysfunction. In this dysfunction, the schizophrenic “experiences himself as an object” rather than as a subject.:208 Frankl suggested that a schizophrenic could be helped by logotherapy by first being taught to ignore voices and to end persistent self-observation. Then, during this same period, the schizophrenic 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”.:216
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.
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 his 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”. Frankl explicitly replied to May’s arguments through a written dialogue, sparked by Rabbi Reuven Bulka’s article “Is Logotherapy Authoritarian?”. 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.
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 and therefore that Logotherapy is founded on Viktor Frankl´s worldview. To the extent that every area of therapy is founded on the worldview(s) of its founder(s), however, the substantiveness of this line of criticism remains opaque.
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?” The American Psychiatric Association awarded Viktor Frankl the 1985 Oskar Pfister Award (for important contributions to religion and psychiatry).