SOURCE_DOCUMENTS/journal_003_1.txt

Number 3 Spring 1980 
CONTENTS 
The Place of Logotherapy in the World Today Edith Weisskopf-Joelson ...................................................... 3 
Kinship with Adlcrian Psychology Heinz L. Ansbacher .......................................................... 7 
Logotherapy and Religion Hedwig Raskob ............................................................. 8 
Frankl's Contributions to the Graduate Program at the USIU W.Ray Tucker .............................................................. 12 
Paradoxical Intention, Viewed by a Behavior Therapist 
L. Michael Ascher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 
Treatment of Problem Drinkers James C. Crumbaugh ....................................................... 17 
Logotherapy's Contribution to Youth Helen C. Roberts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 
Logotherapy and the College Student Mignon Eisenberg .......................................................... 22 
The Third Culture of the Young Eugenio Fizzotti ............................................................ 25 
A Center of Logotherapy in Italy ................................................. 26 
Logotherapy and Education in a Post-Petroleum Society Arthur G.Wirth ............................................................. 29 
Viktor Frankl: A Precursor for Transpersonal Psychotherapy Kenneth Kelzer, Frances Vaughan, and Richard Gorringe ........................ 32 
A Personal Recollection Alexandra Adler, M.D....................................................... 35 
Karol W ojtyla and Logotherapy Kazimierz Popielski ......................................................... 36 
Logotherapy and Social Change Guillermo Pareja-Herrera .................................................... 38 
Three Faces of Frankl Joseph Fabry ............................................................... 40 
Frankl's Impact on Jewish Life and Thought Reuven P. Bulka ............................................................ 41 
Visits to Auschwitz and Dachau Robert C. Leslie ............................................................ 43 
Logotherapy as a Theory of Culture 
Walter Bo.ckmann ........................................................... 44 The Anthropological Foundations of Logotherapy Paul Polak ................................................................. 46 Behut Dich Gott Elisabeth Kubler-Ross ....................................................... 48 Logotherapy in Outplacement Counseling Frank Humberger ........................................................... 50 My "Second Meeting" with Viktor Frankl Mignon Eisenberg .......................................................... 53 The Fourth Human Dimension Hiroshi Takashima .......................................................... 54 Foundation Formation and the Will to Meaning 
Adrian van Kaam ........................................................... 57 Book Reviews .................................................................. 60 Bibliography ................................................................... 64 
2 
Psychotherapy on its Way to Rehumanism 
Viktor E. Frankl 
In my young years I met both Sigmund Freud and Alfred Adler, and was invited by both to contribute an article to their international journals of psychoanalysis and individual psychology. (They were published in 1924 and 1925). The Freudian and Adlerian views on psychotherapy were diametrically opposed to each other. But this is a general phenomenon. Everywhere we open the book of psychotherapy we are confronted with two pictures of the human being, so to speak, that not only differ but even contradict each other. 



Figure 1 
If we symbolize such mutual contradictions by a square and a circle on facing pages, it may occur what we know from mathematics: the problem of squaring the circle proves to be unsolvable. But if we turn the left page up perpendicular, we can imagine the square and the circle to be two-dimensional projections of a three-dimensional cylinder, representing its profile view and its ground plan. The contradictions between the pictures no longer contradict the oneness of what they depict. 
~ 
Figure 3 
Another contradiction disappears as soon as we conceive the pictures as mere projections. If we assume the cylinder is not a solid but rather an open vessel -say, an empty cup ~ this openness, too, disappears in the lower dimensions: both the square and the circle are closed figures. But once we view them as mere projections, their closedness no longer contradicts the openness of the cylinder. 
3 


Figure 4 
This simile also applies to our concept of the human being, tc> our anthropological theory as it -explicitly or implicitly-underlies our psychotherapeutic practice. The contradictions between the disparate pictures of the human being, as they are presented by the different psychotherapeutic schools, cannot be overcome unless we proceed into the next higher dimension. As long as we remain in the physio-psychological dimensions onto which we have projected the human person, there is no hope for a unified concept. Only if we open up the next higher, the human dimension with its specifically human phenomena, only if we follow th-e human person 
into this dimension, is it possible to catch the oneness as well as the humanness. Entering the human dimension becomes mandatory if we are to tap those resources which are available solely in the human dimension, in order to incorporate them into our therapeutic armamentarium. 
The Human Resources 
Among these resources two are most relevant for psychotherapy: the human capacities of self-detachment and self-transcendence. 
Self-detachment is the capacity to detach ourselves from outward situations, to take a stand toward them; but we are capable not only of detaching ourselves from the world but also from ourselves. This capacity is mobilized in the logotherapeutic technique of paradoxical intention. I started practicing it in 1929 at the Psychiatric Hospital of the University of Vienna Medical School, published it the first time in 1939, 6 and coined the term "paradoxical intention" in 1947.7 
The following passage from this book written 33 years ago7 shows the theoretical grounds on which paradoxical intention is based. (The quotation also may build a bridge of mutual understanding between logotherapists and behavior therapists). "All psychoanalytically oriented psychotherapies are mainly concerned with uncovering the primary conditions of the 'conditioned reflex' as which neurosis may well be understood, namely, the situation -outer or inner -in which a given neurotic symptom emerged the first time. It is the author's contention, however, that the fullfledged neurosis is caused not only by the primary conditions but also by secondary conditioning. This reinforcement, in turn, is caused by the feedback mechanism called anticipatory anxiety. Therefore, if we wish to recondition a conditioned reflex, we must unhinge the vicious cycle formed by anticipatory anxiety, and this is the very job done by our paradoxical intention technique." 
This technique lends itself to the treatment of phobic and obsessive-compulsive conditions. In phobics, a given symptom evokes in the patient a phobia in the form of the fearful expectation of its recurrence; this phobia provokes the symptom actually to occur; and the recurrence of the symptom reinforces the phobia. 

SYMPTOM PHOBIA 

Figure 5: The First Circle Formation: Phobias 
In some cases the object of the "fearful expectation" is fear itself. Our patients spontaneously speak ofa "fear offcar." Upon closer interrogation it turns out that they are afraid of the consequences of their fear: fainting, coronaries, or strokes. As I pointed out in 19539 they react to their "fear of fear" by a "flight from fear" -what one might call an avoidance pattern of behavior. In 1960 I had 
4 
arrived at the conviction that "phobias are partially due to the endeavour to avoid the situation in which anxiety arises. "10 This contention has been confirmed by behavior therapists on many occasions. 
Along with the phobic pattern which we may circumscribe as a "flight from fear," a second pattern -the obsessive-compulsive one -is characterized by a "fight against obsessions and compulsions." The patients are afraid that they might commit suicide or homicide, or that the strange ideas haunting them might be the precursors, if not already the symptoms, of a psychosis. These patients are afraid not of fear itself but rather of themselves. 
Again. a circle formation is established. The more the patients fight their obsessions and compulsions the stronger these symptoms become. Pressure induces counterpressure, and counterpressurc. in turn, increases pressure. 

I'HESSUHE COUNTEHPHESSUHE 

Figure 6: The Second Circle Formation: Obsessions and Compulsions 
To break these vicious circles. the first thing to do is to take the wind out of the sails of the anticipatory anxieties underlying them. and this is precisely the goal of paradoxical intention. The patients are encouraged to do, or wish to happen, the very things they fear---albeit with tongue in check. "An integral clement in paradoxical intention," writes Lazarus.17 "is the deliberate evocation of humor." After all, the sense of humor is one aspect of the specifically human capacity of self-detachment. No other animal is capable of laughing. 
In paradoxical intention, therefore. the patients are invited to exaggerate their fears and anxieties, and to do so with as humorous formulations as possible.Numerous examples are quoted in the pertinent literature.10, 11.20 
Hand et a/.12 who had treated chronic agoraphobia patients in groups, observed that the patients spontaneously used humor as an impressive coping device: "When the whole group was frightened, somebody would break the ice with a joke. which would be greeted with the laughter of relief." They reinvented paradoxical intention, one may say. 
Paradoxical intention has been effective 
even in severe cases. Lamontagne14 cured a 
case of incapacitating erythrophobia that had 
been present for twelve years within four 
sessions. Niebauerl6 successfully treated a 
65-year-old woman who had suffered from a 
hand-washing compulsion for sixty years. 
Jacobsl3 cites the case of Mrs. K who for 
fifteen years had suffered from severe claus
trophobia and was cured within a week. His 
treatment was a combination of paradoxical 
intention. relaxation, and desensitization, a 
fact demonstrating that paradoxical inten
tion, or for that matter logotherapy, does in 
no way invalidate any other, or previous, 
psychotherapies but rather presents a means 
to maximize their effectiveness. In the same 
vein, Ascher2 points out that "most thera
peutic approaches have specific techniques," 
and "these techniques are not especially useful 
for, nor relevant to, alternative therapeutic 
systems." There is "one notable exception in 
this observation," namely paradoxical inten
tion. "It is an exception because many 
professionals representing a wide variety of 
disparate approaches to psychotherapy have 
incorporated this intervention into their 
systems both practically and theoretically." 
In fact, "in the past two decades. paradoxical 
intention has become popular with a variety 
oftherapists"who had been "impressed by the 
effectiveness of the technique." Even more 
important, "behavioral techniques have been 
developed which appear to be translations of 
paradoxical intention into learning terms." 
Ascher and Turner3 were the first to come up 
with a "controlled experimental valiJation of 
the clinical effectiveness" of paradoxical 
intention in comparison with other behavioral 
strategies. Solyon et a/.21. too, proved 
experimentally that paradoxical intention 
works. 
5 
Self-Transcendence 
model). In either way, the human being is 
The second human capacity, that of self
dealt with as a world-less monad or a closed 
transcendence, denotes the fact that being human always points, and is directed, to something or someone other than oneself -to meanings to fulfill or to other human beings lovingly to encounter. Only to the extent to which we live out our self-transcendence are we really becoming human and actualize ourselves. Thi5 always reminds me ofthe fact that the capacity ofthe eye visually to perceive the surrounding world, ironically, is contingent on its incapacity to perceive itself. Whenever the eye sees something of itself its function is impaired. If I am affected by a cataract, I see a cloud -my eye secs its own cataract. Or if I am affected by a glaucoma, I see a rainbow halo around the lights -my eye perceives, as it were, the heightened tension that causes the glaucoma. The normally functioning eye does not see itself, it is rather overlooking itself. Similarly we are human to the extent to which we overlook and forget ourselves by giving ourselves to a cause to serve or to another person to love. By being immersed in work or in love we are transcending and thereby actualizing ourselves. 
The question has been raised why the selftranscending quality of the human reality has been so widely ignored by psychology. As I see it, this has something to do with the Heisenberg law which, restated a bit freely, says: The observation of a process unavoidably and automatically influences the process. Something similar holds for the strictly scientifically (rather than phenomenologically) oriented observation of human behavior: it cannot escape making a subject into an object. But, alas, it is the inalienable property of a subject that it has objects of its own. (According to the terminology of the Brentano-H usserl-Scheler phenomenology, they are called "intentional objects'" or "intentional referents.") Undcrstandable, that the moment the subject is made into an object, its own objects disappear. And inasmuch as the "intentional referents" form "the world in" which a human being "is," as a "being-in-theworld," to use the often-misused Hcideggerian phrase, the world is shut out as soon as a person is seen no longer as a being acting into the world but rather as a being reacting to stimuli (the behavioristic model) or abreacting drives and instincts (the psychodynamic system, and as illustrated in figure 4, the openness of a vessel projected onto lower dimensions disappears. 
Human behavior, then, is really human to the extent to which it means "acting into the world." This, in turn, implies being motivated by the world. In fact, the world toward which a human being transcends itself is a world replete with meanings (which constitute the reasons to act) and other human beings (who constitute the persons to love). As soon as we project human beings onto the dimension ofa psychology which is strictly scientifically conceived, we cut them off from the world of potential reasons. What is left, instead of reasons, arc causes. Reasons motivate me to act in the way I choose. Causes determine my behavior unwittingly, whether I know it or not. When I cut onions I weep; my tears have a cause but I have no reason to weep. When I lose a friend I have a reason to weep. 
And what are the causes that are left to the psychologist with a blind spot for self-transcendence and consequently for meanings and reasons? If he is a psychoanalyst, he will substitute for motives some drives and instincts as causes for human behavior. Ifhe is a behaviorist, he will see in human behavior the mere effect of conditioning and learning processes. If there arc no meanings, no reasons, no choices, determinants have to be hypothesized, one way or another, to replace them. Under these circumstances, the humanness of human behavior is done away with. If psychology or, for that matter, psychotherapy is to be rehumanized, it has to remain cognizant ofself-transcendence rather than scotomizing it. 
One important aspect ofself-transcendence is what is called in logotherapy "the will to meaning." If we can find and fulfill a meaning in our life we become happy but also capable of coping with suffering. If we can sec a meaning we are even prepared to give our life. On the other hand, if we cannot see a meaning we are inclined to take our life, even in the midst of and despite all the welfare and affluence surrounding us. Consider the escalating suicide figures in welfare states such as Sweden and Austria. To quote L. Bachelis4, director ofthe Behavioral Center in 
6 
New York, "many undergoing therapy at the center tell (us) they have a good job, they are successful but want to kill themselves because they find their life meaningless." I do not intend to say that most suicides are undertaken out ofa feeling of meaninglessness but I am convinced that people would overcome their impulse to kill themselves if they see a meaning in their lives. They have the means to live but no meaning to live for. Logotherapy faces squarely the situation confronting us in a "post-petroleum society" and even "has special relevance during this critical transition. "23 
Countering Hyperreflection 
Happiness is not only the result offulfilling a meaning but also, more generally, the unintended side effect of self-transcendence. It therefore cannot be "pursued" but rather must ensue. The more we aim at happiness and pleasure the more we miss the aim. This is most conspicuous with sexual pleasure, and it is characteristic of the sexually neurotic pattern that people directly strive for sexual performance ofexperience. Male patients try to demonstrate their potency and female patients their capacity for orgasm. In logotherapy, we speak of"hyperintention" in this context. Because hyperintention is often accompanied by what we call in logothcrapy "hyperref1ection," i.e., too much self-observation, both hyperintention and hyperreflectionjoin to form still another, the third, circle formation. 
GIVING ONESELF 
HYPFRINTENTION HYPERRFFLFCTION 
FORGETTING ONESELF 
Figure 7: The Third Circle Formation: Sexual Dysfunctions 
To break the circle, centrifugal forces must be brought into play. Hyperreflection can be counteracted by the logothcrapeutic technique of "dereflection": the patients, instead of watching themselves, should forget themselves. But they cannot forget themselves unless they give of themselves. 
Again and again it turns out that the hyperintention of sexual performance is caused by the patient's sexual achievement orientation and tendency to attach to sexual intercourse a "demand quality." To remove it is the purpose of a logotherapeutic strategy which, in addition to the dercf1ection technique, I first described in English in 19528 and more elaborately in The Unheard Cry for Meaning. I I Sahakian and Sahakian19 were the first to point out what later was confirmed by Ascher 1and most recently by Bulka5 who sees in deref1ection "a clear anticipation of the approach of Masters and Johnson." 
Three A venues to Meaning 
The feeling of meaninglessness not only underlies the mass neurotic triad of today -depression, addiction, aggression -but also may result in what we logotherapists call a "noogenic neurosis." So far ten researchers have, independently from each other, estimated that about 20 per cent of neuroses are noogenic (cf. Klingerl5). In such cases, logotherapy offers a specific procedure to help the patient find meaning. Logotherapy is based on a logotheory, and the logotheory, in turn, is empirically based. The logotherapist never prescribes meaning but may well describe how the process of meaning perception is enacted by the "man or woman in the street," through what I call their "unreflected ontological self-understanding." Logotherapists neither preach meaning nor teach it but learn it from people who for themselves have discovered and fulfilled it. 
A phenomenological analysis reveals that there arc three main avenues to arrive at meaning. The first is finding it by creating a work or by doing a deed. It is unbelievable how inventive a simple person may become when it comes to squeezing out meaning from a life that appears to lack it. 
Several years ago a garbag': collector received the order of merit from the German government. This man did his job to everyone's satisfaction but the special effort 
7 
that gained him the award was this: He looked through the garbage cans for discarded toys, spent his evenings to repair them, and gave them to poor children as presents. Talented as a fix-it man he added to his cleanup job a magnificent meaning.18 
In addition to the meaning potential inherent in creating and doing, a second avenue is available in experiencing something or encountering someone: Meaning can be found not only in work but also in love. Weisskopf-Joelson22 observes in this context 
that the logotherapeutic "notion that experiencing can be as valuable as achieving is therapeutic because it compensates for our onesided emphasis on the external world of achievement at the expense of the internal world of experience." 
Most important, however, is the third avenue to meaning, that of attitudes. Even if we are the helpless victims of a hopeless situation, facing a fate that cannot be changed, we may rise above ourselves, grow beyond ourselves, and by so doing change ourselves. We may turn a personal tragedy into a triumph. 
A few years after World War II a doctor examined a Jewish woman who wore a bracelet made of baby teeth mounted in gold. "A beautiful bracelet," the doctor remarked. "Yes," the woman answered, "this tooth here belonged to Miriam, this one to Esther, and this one to Samuel..." She mentioned the names of her daughters and sons according to age. "Nine children," she added, "and all of them were taken to the gas chambers." Shocked, the doctor asked: "How can you live with such a bracelet?" Quietly, the Jewish woman replied: "I am now in charge of an orphanage in Israel'.'18 
For a quarter ofa century I was running the neurological department ofa general hospital and bear witness of the patients' capacity to turn their predicament into a human achievement. I have seen young men who yesterday were skiing in the Austrian Alps or riding a Yamaha and today were paralyzed from the neck down. Or girls who yesterday were dancing in a disco and today are confronted with the diagnosis of a brain tumor. P.L. Starck, a nurse working in Alabama, reported to me: 
I have a 22-year-old female client who was injured at age 18 by a gunshot as she walked to the grocery store. She can only accomplish tasks by use ofa mouthstick. 
She feels the purpose of her life is quite clear. She watches the newspapers and television for stories of people in trouble and writes to them (typing with her mouthstick) to give them words of comfort and encouragement. 
Beause meaning may be "squeezed out" even from suffering, life proves to be potentially meaningful literally to our last breath. In no way, however, is suffering necessary to find meaning. But meaning is possible even in spite of suffering. This holds true, of course, only for unavoidable suffering. If it were avoidable, the meaningful thing to do would be to remove its cause, be it psychological, biological, or political. To suffer unnecessarily is masochism, not heroism. But if we cannot change a situation that causes our suffering, we still can choose our attitude. won't forget an interview I heard on Austria's TV screen, given by a Polish cardiologist who during World War II had organized the Warsaw ghetto upheaval. "What a heroic deed," exclaimed the reporter. "Listen," calmly replied the doctor, "to take a gun and shoot around is no great thing. But if the SS leads you to a gas chamber or to a mass grave to execute you on the spot, and you can't do anything about it -except to keep your head 
8 
high and go your way with dignity, you see, 
that is what I would call heroism."* 
Life is potentially meaningful under any 
condition, be they pleasurable or miserable, 
and precisely this cornerstone of logotherapy 
has been corroborated on strictly empirical 
grounds, through tests and statistics applied 
to tens of thousands of subjects (p. 40).11 The 
overall result was that meaning is in principle 
available to everyone irrespective of sex, age, 
IQ, educational background, character struc
ture and environment, irrespective ofwhether 
one is religious or not, and when religious, 
irrespective ofthe denomination to which one 
belongs. 
People suffering from obsessive-compul
sive and phobic conditions who can be helped 
by paradoxical intention are but a minority. 
The majority, however, is not a silent one. To 
those who know to listen, it is rather a crying 
majority-crying for meaning! For too long a 
time the cry has remained unheard. But a 
psychotherapy that sets out "on its way to 
rehumanization" should give a hearing to the 
unheard cry for meaning. 
* An empirical study conducted by Austrian public opinion pollsters evidenced that the individuals held in highest esteem by most of the people interviewed were neither the great artists nor the great scientists, neither the great statesmen nor the great sportsfigures, but those who mastered a hard lot with dignity. 
VIKTOR E. FRANKL, M.D., Ph.D., is professor ofpsychiatry and neurology at the University of Vienna and founder of logotherapy. The present article is based on his address at the symposium "Four Viewpoints of Psychotherapy. " .,ponsored by the Behavior Therapy Unit Eastern Pennsylvania Psychiatric Institute, Philadelphia. 
REFERENCES: 
I. Ascher, L.M., "Paradoxical Intention Viewed by a Behavior Therapist." The International Forum for Logotherapy, I (3). 1980, 13-16 
2. ----,"Paradoxical Intention." In A. Goldstein and E.B. Foa (eds.), Handbook of Behavioral Interventions. New York, John Wiley, in press. 
3. _____ , and R.M. Turner, "A Controlled Comparison of Progressive Relaxation, Stimulus 
Control, and Paradoxical Intention Therapies for Insomnia." Journal of Consulting and Clinical Psychology, in press. 
4. Bachelis, L., "Depression and Disillusionment." A PA Monitor, May 1976. 
5. 
Bulka, R.P., The Quest for Ultimate Meaning: Principles and Applications of Logotherapy. New York, Philosophical Library. 1979. 

6. 
Frankl, V.E.. "Zur medikament6sen Unterstiitzung der Psychotherapie bei Neurosen." Schweizer Archiv fur Neurologie und Psychiatrie. 43, 1939, 26-31. 

7. 
____ , Die Psychotherapie in der Praxis. 


Vienna, Deuticke, I 947. 
8. ____ , "The Pleasure Principle and Sexual Neurosis." International Journal of Sexology. 5, 1952, 128-130. 
9. ____ , "Angst und Zwang." Acta Psychotherapeutica, 43, 1953, 26-31. 
IO. ____ , "Paradoxical Intention: A Logotherapeutic Technique." American Journal of Psychotherapy, 14, 1960, 520-535. 
11. ____ , The Unheard Cry for Meaning. New York, Simon and Schuster, 1978. 
12. 
Hand, I., Y. Lamontagne, and I.M. Marks, "Group Exposure (Flooding) in Vivo for Agoraphobics." British Journal of Psychiatry, 124, 1974, 588-602. 

13. 
Jacobs, M., "An Holistic Approach to Behavior Therapy." In A. A. Lazarus (ed.), Clinical Behavior Therapy. New York, Brunner-Maze!, 1972. 


14. Lamontagne, Y., "Treatment of Erythrophobia by Paradoxical Intention." The Journal ofNervous and Mental Disease, 166, (4), 1978, 304-306 
15. 
Klinger, E., Meaning and Void. Minneapolis, University of Minnesota Press, 1977. 

16. 
Kocourek, K., E. Niebauer, and P. Polak, "Ergebnisse der klinischen Anwendung dcr Logotherapie." in 


V.E. Frankl, V.E. von Gebsattel, and J.H. Schultz (eds.), Handbuch der Neurosenlehre und Psychotherapie, Munich, Urban and Schwarzenberg, 1959. 
17. Lazarus, A.A., Behavior Therapy and Beyond. New York, McGraw-Hill, 1971. 
18. 
Moser, G., Wie finde ich den Sinn des Lebens? Frciburg, Herder, 1978. (The cases cited were translated by .Judith L. Fabry.) 

19. 
Sahakian, W.S., and B.J. Sahakian, "Logotherapy as a Personality Theory." Israel Annals of Psychiatry, I 0. 1972, 230-244. 


20. Shelton, .J.L., and J.M. Ackerman, Homework in Counselinf{and Psychotherapy. Springfield, Charles 
C. Thomas Publishers, 1974. 
21. Solyom, L., J. Gaua-Perez. B.L. Lcdwidge, and C. Solyom, "Paradoxical Intention in the Treatment of Obsessive Thoughts: A Pilot Study." Comprehensive Psychiatry, 13 (3), I972, 291-297. 
22. 
Weisskopf-Joelson, E., "The Place ofLogotherapy in the World Today." The International Forum for Logorherapy, I (3), 1980, 3-7. 

23. 
Wirth, A.G., "Logotherapy and Education in a PostPetroleum Society." The International Forum for Logorherapy, I (3), 1980, 29-32. 


9 
Four Essays by Elisabeth Lukas 

Elisabeth Lukas with Dr. Frankl 
ELISABETH LUKAS is director of a counseling center in Munich, Germany. In 1971, she received her Ph.D. in psychology from the University in Vienna where she studied under Viktor Frankl and wrote her thesis on "Logotherapy as a Personality Theory." She developed her own logotest to conduct the first major validation oflogotherapy and worked closely with Frankl from 1969 to 1972. Heading a team of counselors in Munich she applied logotherapy as primary and complementary therapy in hundreds of cases. While remainingfaithful to Frankl's basic concepts she has creatively expanded the application oflogotherapy to many areas. (See her chapters "The Four Steps ofLogotherapy"and "A Supplementary Form ofTherapy for Addicts" in Logotherapy in Action, and her contributions to previous Forums, "Logotherapy's Message to Parents and Teachers" and "The Ideal Logotherav_ist. ") Two books describing her experiences with logotherapy, are in preparation by the Herder Publishing Company in Germany. The 
followingfour articles are taken from the as yet unpublished materials. They have been edited and translated by Joseph Fabry. 
The Logotherapy View of Human Nature 
The full picture of the human being is slowly emerging from the assumptions and discoveries of early psychology. Psychoanalysis perceived that human beings are shaped by their past experiences, including childhood traumas and conflicts. Behavior therapy recognized that they arc also shaped by how they have learned to behave. Humanistic and existential schools of psychology of the postwar years have pointed out that human beings arc more than mere victims of their past and mere results of their learning, but that they are masters of their lives to a greater extent than they have been given credit for. 
A therapy that sees patients primarily as victims and results will concentrate its attention on what's wrong with them and neglect their capacity to develop what's right with them. Viktor Frankl was the first psychiatrist who, in the early thirties, pointed out that the medical profession, to make and keep patients healthy, must not neglect the human spirit and its "defiant power" that can take a stand against past traumas and faulty learning, and thus release the self-healing power of the human being. He advocated the idea that the therapist is more than an interpreter or manipulator but a person who takes the 
patients and their complaints at face value instead of assuming hidden motives and misguided learning. 
Overcoming Basic Assumptions 
Such a therapist has to overcome two basic assumptions of earlier psychological theories about human nature. The first is the assumption that even adults are not accountable for their decisions -one might call this the assumption of an a priori guardianship. The second assumption that had to be overcome saw human beings as exclusively oriented toward seeking pleasure and gaining advan
tages. 
In psychoanalytical philosophy, the a priori 
guardianship is expressed by presenting the 
unconscious, with its repressed drives and 
impulses, as a ready excuse for harmful 
behavior. The murderer kills because he is 
overwhelmed by repressed aggressiveness 
rooted in a lack of Jove experienced in child
hood. Behaviorism sees the killing as a result 
of the murderer not having learned any other 
reaction to a provocation but to hit or behave 
in some other uncontrolled manner. His 
aggressiveness has been reinforced, one way 
or another, and so he continues his learned 
behavior patterns up to homicide and murder. 
Human beings are seen as automatons, pre
programmed, no longer able to control their 
actions. The a priori guardianship is thus 
explained by behaviorists in a different way 
than in psychoanalysis, but the result is the 
same -an excuse for irresponsible behavior. 
The question is not raised as to whether a 
human being may be able to retain at least 
some semblance of freedom to decide, even 
under conditions of extreme anger or excite
ment, whether to kill or not to kill. The 
question would force psychologists to deal 
with such unscientific and unquantifiable 
concepts as conscience, responsibleness, and 
guilt. A positive answer would presuppose 
some degree of freedom of will which neither 
orthodox psychoanalysis nor orthodox behaviorism is willing to grant. Freedom ofwill is not compatible with seeing the person as a driven or computerlike creature shaped by forces of repression or reinforcements. Freedom ofwill opens a new dimension where the old hypotheses of cause and effect are not an answer. 
The second assumption -that the human being is motivated by seeking pleasure and material advantages -seemed justified by psychological research. Psychoanalysis saw human nature as striving for the satisfaction of drives and needs, and neurosis was a possible consequence when this chase after pleasure was blocked. Behavior therapy tended to see human nature reacting to rewards and punishments, mostly of a material kind. In both cases human action was motivated by the continuing pursuit of pleasure, material success, and recognition. 
Frankl's early warning -that the will to pleasure and the will to success, although important motivations, were secondary to the will to meaning -went unheard for a long time. Then affluence came to the Western world, with its abundance of material goods, luxuries, shorter working hours. the possibilities to enjoy pleasures reserved previously only to the idle rich, including the newly won freedom to enjoy sexual '.lctivities. Yet, contrary to psychological theories, people were not healthier. The number of the mentally sick, the suicides, the addicts, the violent, those without direction, the sexual failures increased sharply. Clients looking for help in counseling centers are not primarily those who have to endure unbearable sufferings rooted in the past or experienced in the present, but those who don't know what to do with their lives. They have no goal to struggle for because they see no values worth living, much less sacrificing for. Their lives are empty. They are bored, frustrated, anx10us. 
Frankl's picture of the human being includes the human spirit, a dimension still largely ignored in therapy, just as the psychological dimension was ignored in the early days of Freud. 
The inclusion of the human spirit does not mean that we are to deny our animal-like drives and emotions, or our desire to be successful and materially secure. But it does mean the acknowledgment of a dimension 
II 
where we are free to decide whether we give in to our impulses or resist them. The spirit is the dimension where a potential murderer, even if provoked, can take a stand against his drives. In the dimension of the spirit even severe and unavoidable suffering can be overcome by a change of attitudes that can turn the suffering into a human achievement. In their spirit human beings are free to deny themselves pleasure if they see meaning behind the denial. Here, they are not dominated by the pleasure principle, but can make decisions according to the meaning principle. Frankl's philosophy and therapy are based on the assumption -increasingly supported by empirical evidence --that the human being is motivated to live and to act not so much by having something to live on, but something to live for, a task to fulfill, an idea to realize, a goal to reach. These are old verities, intuitively accepted by the man and the woman in the street but not yet in psychiatric clinics and counseling centers. Suppose you invite a mother of two small children, struggling to make a living, to a dream villa on the Riviera where she can loll on the beach and eat lobster and caviar, and she will say, regretfully: "How can I go away, who will take care of my kids?" This decision cannot be explained by saying she simply follows her motherly instincts, or that she had never learned a different behavior than to serve her family. Such explanations devaluate her basic humanness by placing her action below the human and spiritual level an example of a malignant reductionism. What asserts itself here is her will to meaning, the voice of her conscience. Her decision goes against the pleasure principle: she would rather be on the beach eating lobster than washing diapers at home. But she has a task to fulfill, she is needed by her children, she would not be able to enjoy her luxuries knowing that they are at home, unattended. 
Motivation in the Affluent Society 
On the marketplace of the affluent society everything can be bought except meaning. Industry produces thousands of articles to satisfy the pleasure principle, and life becomes empty. The children sit in their own rooms filled with expensive toys, and are bored. Their parents work to afford the new freezer, the second car, and all the luxuries that have become meaningless. The young try to break out of that trap; in their desperate search for some remammg values and ideals they stumble into cults, drug abuse, violence, terrorism, political excesses, destructive pro-· tests. On weekends the family rushes to amusement centers, they fly to far-away vacation spots, they never come to a standstill, they never come to their senses, they never quiet down to a conversation that goes much below surface chats. The television programs simulate a harmony that no longer exists, or accentuate violence. People live apart, they live for themselves, they live without a purpose. Clinics are overcrov, ded, people are sick, suffering from the meaninglessness of an affluent life that is worth much in material things but hardly worth living. 
However, there are now signs that affluence is subsiding. Perhaps the energy crisis, the economic crisis, the political crisis are warning signals that human self-understanding as primarily meaning-oriented creatures is necessary for survival. Perhaps the drug of affluence, which we have all swallowed, will help us, not to hallucinate but to face reality: that human beings are not primarily concerned with satisfying needs and experiencing reinforcements but with perceiving and pursuing meaningful goals. Emotions may often misguide us, but our will can move mountains. Conditioned reflexes may lead us astray, but our intellect can rediscover the right way. We have evolved from animals but we do possess the uniquely human dimension of the spirit that lifts us above the animal level. Our brain functions like a computer but our conscience helps us resist any brainwashing preprogramming. 
We are full ofcontradictions, but the ability to live with contradictions is a specific human quality which enables us to contradict even our drives and our learned behavior, and to overcome our limits, failures, and weaknesses. This self-image presupposes a trust in human nature. The logotherapeutic picture of the human being is permeated by a trust in our full humanness. It does not reduce human actions to egoistic motives that must be unmasked, or to mechanisms that must be manipulated. Logotherapy sees human beings in their fullness, including their capacity to suffer, to experience guilt, and to face death. This picture of human nature opens new vistas. The view that we are able to live fully, in the face of unavoidable suffering, 
12 
inerasable guilt, and the certainty of death nature because it perceives human nature at 
(which Frankl calls "the tragic triad") is a the highest level. reason for hope, belief, and trust in human 
The Best Possible Advice 
Psychotherapeutic counseling consists of three phases: diagnosis, therapy, and follow-up. 
During the diagnostic phase the therapist tries to get information about the client by taking the medical history, through examinations, questionnaires, tests, and in-depth interviews. 
The purpose of the therapeutic phase is to help clients overcome their difficulties through a therapy plan including psychological techniques, direct and indirect counseling, medication, dialogues, and cooperative efforts. 
In the follow-up phase the therapist wants to keep the clients psychologically healthy and independent after conclusion of therapy. This phase may include follow-up dialogues and referrals. 
These phases have undergone changes. Fifty years ago, the diagnostic phase was exceedingly long, the therapeutic phase short, and the follow-up phase practically nonexistent. Today, the therapeutic phase has overtaken the diagnostic one in significance while the importance of the follow-up is only beginning to be understood. 
The success of each phase depends on the favorable termination of the previous one. Therapy will fail after an incorrect diagnosis, and no follow-up is possible after an unsuccessful therapy. Each phase has its own methods which differ according to the basic school of therapy used, but over the past years the methods have generally improved in effectiveness. Each phase also has its dangers which may disturb, and even break up the contact between therapist and client. The situation improves as the human relationship between the two becomes firmer. The dangers of a breakup are greatest during the diag
nostic phase, but resistance may also occur during therapy, and saturation during the follow-up. Because therapists are dependent on client response, they too may feel uneasy and even hostile if there is no response evasive answers during the diagnostic phase, opposition to the help offered during the therapy, and the lack of feedback during the follow-up. 
In applying logotherapeutic principles during the three phases, one must realize that there is no such thing as a specifically logotherapeutic diagnosis; that in therapy more is needed than logotherapeutic techniques; and that the follow-up requires knowledge that goes beyond logotherapy. But while it is true that pure logotherapy is not enough for psychological counseling, it is also true that such counseling is incomplete without application of logotherapeutic principles. These principles are not universal guidelines but a professional supplement to optimal living, regardless of the approach used. 
This essay discusses the "best possible advice" in logotherapeutic counseling. In the diagnostic phase the best advice would be to not cause "iatrogenic" problems and to counteract "hyperreflection." In the therapy phase, it would be the application of specific logotherapeutic techniques and the modification of unhealthy attitudes. During the follow-up, attention would be focused on helping clients find specific meanings and on broadening their base of values. 
THE DIAGNOSTIC PHASE 
During the diagnostic phase the counselor attempts to identify the client's problems and the reasons why they could not yet be 
13 
inerasable guilt, and the certainty of death nature because it perceives human nature at 
(which Frankl calls "the tragic triad") is a the highest level. reason for hope, belief, and trust in human 
The Best Possible Advice 
Psychotherapeutic counseling consists of three phases: diagnosis, therapy, and follow-up. 
During the diagnostic phase the therapist tries to get information about the client by taking the medical history, through examinations, questionnaires, tests, and in-depth interviews. 
The purpose of the therapeutic phase is to help clients overcome their difficulties through a therapy plan including psychological techniques, direct and indirect counseling, medication, dialogues, and cooperative efforts. 
In the follow-up phase the therapist wants to keep the clients psychologically healthy and independent after conclusion of therapy. This phase may include follow-up dialogues and referrals. 
These phases have undergone changes. Fifty years ago, the diagnostic phase was exceedingly long, the therapeutic phase short, and the follow-up phase practically nonexistent. Today, the therapeutic phase has overtaken the diagnostic one in significance while the importance of the follow-up is only beginning to be understood. 
The success of each phase depends on the favorable termination of the previous one. Therapy will fail after an incorrect diagnosis, and no follow-up is possible after an unsuccessful therapy. Each phase has its own methods which differ according to the basic school of therapy used, but over the past years the methods have generally improved in effectiveness. Each phase also has its dangers which may disturb, and even break up the contact between therapist and client. The situation improves as the human relationship between the two becomes firmer. The dangers of a breakup are greatest during the diag
nostic phase, but resistance may also occur during therapy, and saturation during the follow-up. Because therapists are dependent on client response, they too may feel uneasy and even hostile if there is no response evasive answers during the diagnostic phase, opposition to the help offered during the therapy, and the lack of feedback during the follow-up. 
In applying logotherapeutic principles during the three phases, one must realize that there is no such thing as a specifically logotherapeutic diagnosis; that in therapy more is needed than logotherapeutic techniques; and that the follow-up requires knowledge that goes beyond logotherapy. But while it is true that pure logotherapy is not enough for psychological counseling, it is also true that such counseling is incomplete without application of logotherapeutic principles. These principles are not universal guidelines but a professional supplement to optimal living, regardless of the approach used. 
This essay discusses the "best possible advice" in logotherapeutic counseling. In the diagnostic phase the best advice would be to not cause "iatrogenic" problems and to counteract "hyperreflection." In the therapy phase, it would be the application of specific logotherapeutic techniques and the modification of unhealthy attitudes. During the follow-up, attention would be focused on helping clients find specific meanings and on broadening their base of values. 
THE DIAGNOSTIC PHASE 
During the diagnostic phase the counselor attempts to identify the client's problems and the reasons why they could not yet be 
13 
overcome. She looks for symptoms and weaknesses, for past disturbances and traumas, for present hardships and troubles. Many counselors assume that a problem can be mastered only after its origins are understood, and a destructive development can be corrected only after its causes are uncovered. 
While this assumption is correct in theory, the practicing counselor will realize that the diagnostic phase often is confusing to the clients. The probing during this phase does help the counselor get a clearer picture of the problem and a better idea about a functional therapy plan. The more the counselor learns about the client, the better she can fit him in a program that takes into account cause and effect, sickness and treatment, and thus facilitates further work. Once such a program has been established, many counselors tend to stick with it even when subsequent information does not fit. They are inclined not to "hear" information that is at variance with their program, and pay special attention to information that is in accord with it. 
This observation is not meant as criticism. The human problems of the case are often so complex that the counselor, in order not to lose sight of the whole picture, has to simplify. I merely wish to draw attention to the consequences of the diagnostic phase for the clients. Their problems have occupied their mind for a long time, perhaps for years, before they have sought professional help. Because they were not able to solve their problems, these problems seem unsolvable, and clients look to their counselor full of hope, doubt, and anxiety, wondering if she can solve them. In this situation every word and every question of the counselor is highly portentous, and anything she says or does becomes all the more anxiety provoking the less clearly it is understood by the client. Some clients wait breathlessly for the counselor's decision to see if they can be helped at all, and in what way, or whether they may have a "defect" or are "abnormal." 
Because of the counselor's concentration during the diagnostic phase on getting a clear picture of the case, she may not pay much attention to the effects of her questions and statements upon the client. At the same time, the clients listen over-anxiously to her words which seem to pronounce a verdict about their future. During this period of cautious first contacts, clients may suffer irreparable damage which is not intended and not even noticed by the counselor. Iatrogenic neuroses and hyperreflection can be avoided by the sensitivity of the therapist during quiet listening and words used with forethought. 
latros is the Greek word for physician. An iatrogenic neurosis is therefore a neurosis caused by the physician, psychologist, or counselor. It may be triggered by what the physician does or says which the patient, justifiably or not, interprets as "bad news" and thus intensifies his problems. A nrnrologist told a woman suffering from a slight confusion that she had an "attack of paranoia." Her initial symptoms were completely cleared up by medication but the fear of a renewed attack of paranoia still darkens her life, many years after the episode. A long period of anxiety, insecurity, and self-doubt had undermined her self-confidence and preyented her from enjoying life. Although she never had a relapse, and it is not even certain that she actually had a genuine attack of paranoia, she is now suffering from an iatrogenic neurosis caused by a few words of the neurologist who had treated her correctly, freeing her medically from the symptoms that had brought her to him. 
An iatrogenic neurosis starts with the concurrence of two factors: a careless remark or behavior by the physician, and hyperreflection by the patient. Had the neurologist been more careful with his remarks or had the patient not placed so much weight on them, her subsequent neurosis would have been avoided. 
People who lack self-confidence and are 
psychologically unstable tend to hyperreflect: 
they pay exaggerated attention to details that 
concern their person and occupy their 
thoughts. This "circling around oneself' is 
among the most dangerous and unhealthy 
attitudes, it is the "enemy number one" of 
health. Hyperreflection turns minute every
day problems into catastrophes, and minor 
obstacles become insurmountable hurdles. 
The life of a person caught in hyperreflection 
becomes a confusion of countless terrible 
possibilities which could happen, and are a 
burden before they ever do happen. 
Persons constantly worrying about their 
wellbeing will never feel well, and those 
continuously watching themselves for symp
14 
toms of a sickness are already sick. 
Psychologically healthy persons are not without problems but limit their concern to those problems over which they have some control, and look for transcending goals when faced with an inalterable difficult situation. 
The counselor, looking for useful information during the diagnostic phase must watch herself (to avoid iatrogenic neuroses) and watch the clients (to counteract their hyperreflection). 
Iatrogenic Neuroses 
Iatrogenic problems cannot be avoided by nut making diagnostic statements because the counselor's silence can also cause anxiety. Nor can they be avoided by minimizing what the client finds burdensome and significant; the clients may feel that the counselor does not take them seriously or does not understand them. The counselor is well advised to cautiously stick to the truth but present it within the framework of what is meaningful in this case and stress its positive aspects. 
I often have to tell parents that their child is not suited for the "gymnasium" which is the pathway to a college education in Germany. To tell parents the "truth" that their child's intelligence quotient is too low for admittance to a preparatory school for college could cause an iatrogenic problem. They may consider their child "stupid" or "unfit," and thus block the child's potential development. I am not violating the truth by advising the parents to forego an academic education for the child because its talent lies along a practical trade where it is likely to be successful. Parents need the confidence that their child will find its way in life, and this reassurance means more than the giving out of verdicts based on questionable psychological tests. 
A "truthful" answer may also be damaging to clients who ask what's "wrong" with them. The counselor is no liar if she answers this question within a relative framework that includes not only what's wrong but also what's right with the client. 
I once told an extremely frustrated and shy young woman that she was a pleasant exception to the prevalence of excessively selfcentered people around, and that I wanted to help strengthen her assertiveness only to protect her in this egotistic world, and not to change her personality. This "diagnosis" alone lifted her self-confidence and laid the foundation for further logotherapy. To diagnose her as suffering from a seri_ous inferiority complex would not have helped her at all. It might have helped me develop a therapy plan against a problem which I had intensified. 
Iatrogenic problems can be avoided if the diagnosis that needs to be made is linked with some thoughts that prompt a smile in the client. Those who can smile about their problems are on their way toward overcoming them. 
An elderly man asked me anxiously if his pattern of depressive phases would recur for the rest of his life. According to test results I held in my hand this was a likely possibility. I told him: "No one can tell with certainty whether a depression will come back. But we do know for certain that you have come out of your 'downs' every time and lived in long periods of 'ups.' You have so many healthy ups ahead of you that you better start thinking soon about what you are going to do with all this healthy time." The patient acknowledged my answer with a quiet smile although he had well understood the truth. 
Truth is never clear-cut, not in religion, not in physics, and not in psychology. Who can tell which one of the two drunks speaks the truth when one says, "Isn't it terrible, we have hardly sat down on this bench and our bottle is half empty," and the other, "I don't know what you're complaining about. We've sat here for quite a while and our bottle is still half full." 
In the human dimension, truth is always more than truth. It can be the occasion for happiness or suffering, for satisfaction or despair. The success of the therapy may depend on how the counselor handles "truth" in the diagnostic phase -on presenting it in a form that enables the client to accept it with confidence for the future. 
H yperreflection 
Clients tend to suffer from hyperreflection to some degree before they even enter the consulting room, regardless of whether they are really sick or just imagine they arc, and regardless of whether their sickness is serious or not. They have lived with their problem, it has occupied their thoughts. In this regard, the severity of their difficulty is not determined by how real it is but how anxiously they 
15 

Figure 1. The danger of relapse exists after a steep increase of hyperreflection during the diagnostic phase. 
reflect upon it. 
The counselor will begin the diagnostic phase by inquiring about the client's problem in all possible connections. She will ask a woman suffering from insomnia in what circumstances she has trouble falling asleep, what brings on her sleeplessness, how long it has been a problem, in what nightly rhythms it occurs, what medication has been tried, and whatever else seems pertinent. Or the counselor may ask a man with marriage problems how he met his wife, what her good or bad qualities are, how the marriage has developed, what expectations he has, and how far he is prepared to meet his wife's wishes. 
Such questions will intensify the client's initial tendency to hyperrellection. The sleepless woman will observe her sleeping patterns more closely and think about it from all possible angles, and the unhappily married man will keep analyzing himself and his wife, reflecting more and more upon the troubled relationship. 
The result is that the diagnostic phase helps the counselor get much-needed information, but at the expense of intensifying the problem. The therapeutic phase will reduce the heightened hyperreflection which is one of the direct or indirect goals of all therapies. Even psychoanalysis, which tends to encourage hyperreflcction by persistently probing the causes of the present symptoms, reaches in a successful therapy a saturation point when the clients turn away from reconstructing their past, and thus reduce hyperreflection. But no therapy can speedily eliminate the tendency to hyperrellect. Even after the symptoms have been eliminated, clients tend to place undue importance on trivialities which may become a hazard in the follow-up period. My experiences and those of my colleagues have shown that the incidents of relapse are incomparably higher in cases where the counselor had to start the follow-up phase with a client still absorbed in a high level of hyperreflection. 
Clients who are hardly interested in a follow-up because they are occupied with new tasks, who rarely think of their previous problems and don't want to be reminded of them, can be discharged as safe and stable. On the other hand, clients who during the follow-up still think about their former problems as under temporary control but likely to reemerge sooner or later, are in an insecure transition priod which could at the slightest provocation lead into a relapse. 
State of hyper
reflection I 
State of normal reflection 
:Diagnostic . Therapeutic phase ' phase 
. h erreflection 
Us increase m YP
Dangero _ --Possibility of relapse 
. Follow-up, phase 

16 
For years I have tried to find ways to rapidly reduce the clients' hypcrreflection before they are discharged. Today I know that it is the wrong way to allow hyperreflection to build up in the diagnostic phase and then to think about methods of reducing it during and after the therapy. The basic concepts of logotherapy have helped me see that hyperreflection must be counteracted right from the start, even at the expense of information which can be procured later. This procedure presents a dilemma for the counselor because she needs to get early diagnostic information and must ask certain questions and conduct certain inquiries. This dilemma can be solved by a technique which I call "alternate diagnosis." 
Figure 2. Healthy lowering of hyperreflection (after alternate diagnosis) provides a stable base during the follow-up. 
: Diagnostic '. Therapeutic phase : Follow-up phase phase 
State of hyperreflection 

---flea/thy 1 --OO~W~fy~~=-----4.-
-... g Of hyp -~--_;..._______
----+-------------------,._~--erretr
8 . -ect1on 
State of normal reflection 
The alternate diagnosis technique satisfies both requirements of the diagnostic phase: it allows the gathering of information without raising the client's level of hyperreflection. In this technique the counselor's interest alternates between the gathering of information about the problems and the dereflection of the client from his problems toward positive life contents. 
In the case of the woman suffering from insomnia, alternate diagnosis may take the following form: 
A. Query about frequency of sleep disturbances. Talks about such subjects as day-and night rhythms. 
B. Query about activities which the client likes to do and to which she could turn in sleepless hours (reading, listening to music, solving puzzles, cooking). 
C. Discussion of these activities and her 
as1s r. ~ 
or stability 
experiences with them. 
D. Query about connections between emotionally strenuous human encounters and the occurrence of sleep disturbances. 
E. General dialogue about the client's encounters with relatives, friends, acquaintances. 
F. Discussion about possible links between some of these persons and the client's hobbies, inclinations, and interests. 
In this example, two questions (A and D) dealt with the client's symptoms, the other four were set up to counteract the excessive attention to her sleep problems, and to focus her interest on other, more healthy areas of her life. Every question about her sleeplessness might have increased her hyperreflection, but the other questions helped to lower it again so that the client entered her second, 
17 
therapeutic phase, at a level of hyperreflection no higher than she had brought to the diagnostic phase in the first place. (See sketch.) 
Some of my colleagues object to alternate diagnosis because it "prolongs the diagnostic phase unnecessarily." It is true that alternate diagnosis slows down the collecting of the necessary information but this is not an "unnecessary" delay. It facilitates the transition to the therapeutic phase, and the information which during the diagnostic phase seems "superfluous" becomes highly useful in the follow-up period when the clients are led toward meaningful goals and a wide variety of values. 
It is important that the counseling dialogue right from the start of the diagnostic phase include the healthy and positive aspects of the clients' life. This procedure will protect them from additional damage through iatrogenic disturbances, and will also counteract hyperreflection by showing them -after their problems are cleared up -how much life still has to offer. 
THE THERAPEUTIC PHASE 
During the therapeutic phase logotherapists have at their disposal two specific logotherapeutic techniques and the unspecific logotherapeutic procedure of modification of attitudes. 
Specific Logotherapeutic Techniques 
The two specific logotherapeutic techniques are the well-known paradoxical intention, and the less well understood dereflection. 
Paradoxical intention is based on Frankl's 
early discovery I that for phobias and ob
sessions the best possible advice is not to run 
away from the fear or fight compulsions but, 
instead, to "intend" or wish to have happen 
what is feared. A wish and a fear are mutually 
exclusive: What we wish to happen cannot be 
feared. The burden is lifted and the psycho
logical consequences disappear. A phobic 
woman who walks across a bridge with the 
firm intention to collapse in the middle ofit, is 
not able to do it because she is no longer 
overwhelmed by the extreme fear which alone 
could cause her a psychosomatic collapse. 
That she feels "funny" to be wishing for 
something which for years she has feared, 
does not matter. On the contrary: the less 
seriously she takes her attempt, the more she can "smile" about it; the more distance she places between her selfand her symptoms, the more she frees herself for becoming well. 
How paradoxical intention is used in therapy is well documented in logotherapy literature. In counseling, and even among lay people, application is not limited to "sickness." A wife kept threatening her husband with divorce and several times began to pack her suitcases until he gave in to her wishes. One day, instead of participating in this "crisis," he cheerfully helped her pack, suggesting many heavy things to take along, and offering her three extra suitcases, until they both broke up in laughter. A father whose boys constantly fought with each other, suggested just at the crucial moment he would take over the burden of their battle and beat them up himself. When they stared at him in surprise, he suggested calling in a neighbor, a boxing champion, who "could do the job professionally and would not charge a cent for it." 
Paradoxical intention allows people to gain distance from themselves and look at their behavior pattern from the outside and with a sense ot humor. 1t must not be used in such a manner that the clients feel the counselor is laughing at them, but that helps them see, if only for a moment, how ridiculous their actions are. The technique breaks a behavior pattern, snaps it. The woman with the bridge phobia paradoxically intends to stop fearing a collapse and actually tries producing one; the husband, after having been tyrannized by his wife's threatened divorce, suddenly agrees and helps her pack; the father stops scolding his fighting sons and offers to take over the fighting himself. These unexpected reactions strengthen the clients' self-confidence which had been undermined by their long-standing behavior. It is a relief to break out ofthe mesh of patterns, excessive emotions, and automatic reactions, and to see the defiant power of the human spirit in action. 
Dereflection, the second specific logotherapeutic technique to help clients break their psychological shackles, is more difficult to master. Dereflection counteracts the dangers of hyperreflection that traps its victims so they see only their problems and nothing beyond them. The problems dominate; no escape seems possible. The logical outcome of a pathologically magnified hyperreflection 
18 
is suicide -the final exit from a life when all thoughts revolve around a problem that seems unsolvable. 
Human suffering is inevitable, but some is "unnecessary," brought on by the sufferer, often unintentionally. While a modification of attitudes is a therapeutic tool against inevitable suffering, dereflection aims at reducing unnecessary suffering. 
In my counseling practice I am most often asked to help in cases of unnecessary suffering. A man, for whatever initial reason, begins to drink. He neglects his appearance, his acquaintances begin to withdraw. He becomes increasingly lonely which drives him closer to the bottle. He secretly drinks even in his office. His work suffers, he has conflicts with coworkers and his superior, and his anger has to be drowned. He gets fired, undergoes a detoxification cure. After the cure he needs all his strength to resist the temptation of alcohol. But this is not enough. He also needs the strength to look for new employment. He does not succeed and drowns his failure in drinking. His wife rebels -claiming that one stay in a detoxification clinic should have been enough. After the second timc she divorces him and now he is 
more isolated than ever: no friends, no work, no wife. His initial problem of alcoholism has quadrupled; wherever he turns he sees nothing but problems. Under these circumstances a new beginning is an almost hopeless undertaking, but if he stumbles now he is likely to stay down -a victim of alcohol. Yet, his suffering has been unnecessary. With some will power and self-control he could have led a satisfying life among his family, friends, and coworkers. What he needed was something that was more important to him than the bottle, that would have motivated him to say "no" to the bottle, that would have occupied his thoughts more than the next beer. Needed was something that would have broken the deadly hyperreflection on alcohol and would have helped to transcend it. 
Dereflection leads clients to see the multi
tude of values that lie beyond their own weak 
selves. A man who is in danger ofsuccumbing 
to alcoholism can be helped to shake his self
pity and to regain the love of his partner or the 
trust of his supervisor, even if it requires great 
effort. The bottle shrinks to its true size, no 
longer magnified by hyperreflection. 
Similarly, sleeplessness remains a problem as long as it is the center of attention. A woman who accepts the sleep that her body grants her and uses her sleepless hours to work at a task, or merely to think about the task, is on her way to a cure. We must not make our happiness depend on a glass of wine, on undisturbed sleep, on the potency of our body or any other satisfaction of a need, because happiness cannot be captured that way. The best possible advice to the happiness seeker is to dereflect -turning attention to a goal, a task, another person -and to thus stop pursuing happiness and trying to satisfy his needs directly. As Frankl has put it, happiness ensues if it comes as a by-product of having found meaning. 
Once I visited a home for severely retarded children in the company oftwo students. One of them remarked: "Terrible how these children suffer. I never could work here, I couldn't bear to watch them." The other one said: "Well, if I knew there were not enough attendants available I wouldn't mind working here because every helping hand and every bit of love is needed." Both were compassionate, but the first thought about his own feelings, the other about the children. If we realize we arc needed, our strength grows to tackle the task. Ifwe concentrate on wondering whether our strength is sufficient, we pay attention to our weaknesses and feel frustrated. 
Dereflection directs attention to a goal beyond the self. The dereflectory advice to persons suffering from psychogenic sexual dysfunction may be: "Don't observe your own potency, think of your partner." To the insomniac: "Don't worry about your sleep, use your time to write, paint, think about possible solutions to a problem that is bothering you." To the overweight person: "Forget sweets and your dieting, and keep on sewing that new beautiful slim-line dress." 
It is difficult to get a person not to think about a troubling problem. The technique requires creative improvisations by the counselor, but it is worth the effort because it contains the key to the human spirit where the will to meaning can overcome the will to satisfy needs. 
Attitude Modification 
The modification ofattitudes is therapeutic for clients facing unavoidable suffering. 
19 
During the diagnostic phase the counselor, to avoid iatrogenic problems, must consider in her statements the relativity of truth. During the therapeutic phase the counselor, to help clients overcome despair, must show them the relativity of values. She must enable a client, who is suffering through an inalterable situation, to see some value in that situation. For instance, the counselor may discuss with a woman whose leg was amputated whether the value of human existence depends on the use of two legs, and explore opportunities for her to find meaning despite, and even because of, her one-leggcdness. Clients are often in despair because of a loss they cannot accept. Logotherapy suggests some take-off points for a best-possible bit of advice in such situations. A modification of attitudes may start with the consideration that "nothing [in the past] is irrevocably lost but everything is 
irrevocably stored" (p. 191 ).2 
A recent widow may find consolation in the thought that not the length of a life made up the essential value of her husband but all those individual qualities that had made him worth her love -and that these qualities arc not wiped out by his death. Modification of attitudes is discussed more fully in a separate article in this issue. 
Attitude is not determined by the situation 
but by the person. The first foggy fall days 
and the dropping of leaves arc not bound to 
make us feel sad. We may associate fall with 
cozy evenings in front of the fire and the 
fragrance ofpine needles. The observer alone 
determines by her attitude the emotional 
impact of her surroundings, and her attitude, 
in turn, influences her psychological health. 
The therapist will use attitude modification 
with clients who face a situation with an 
attitude so unhealthy or negative that it 
influences their mood, their self-image and 
therefore their behavior. 
It is difficult to change a person's mood 
directly from negative to positive but a modi
fication ofattitudes can be accomplished with 
relative ease. To cheer up a sad person is 
incomparably harder than to discuss with 
them the possibilities that the situation that 
makes them sad may offer some hidden 
meanings or the opportunity for inner growth 
and catharsis. 
One widely held unhealthy attitude today is 
the conviction that, for one reason or another, we simply are not able to do what we basically wish to do. Clients often quote reasons they have picked up from popular psychology literature. Mr. A cannot love because his mother neglected him as a child; Mrs. B cannot help being grouchy in the morning because she has not had her second cup of coffee; the obese Mrs. C cannot pass a candy shop because she has a deep-seated compulsion to buy sweets; Mr. D cannot be assertive because he has an inferiority complex; Mrs. E cannot have a good marriage because her parents denied her the right kind of rolemodcling. 
Practically all these persons are able to overcome their blocks but they don't know it because their attitude prevents them from trying. Thousands of people prove daily that a morning grouch can be friendly before drinking coffee, phobics enter overcrowded supermarkets, people with disastrous childhoods arc happily married, and nonassertivc people arc successful. Many clients do not even try because they arc convinced they will fail, and are caught in a vicious circle of negative expectations and of failures that seem to confirm their expectations. If we do not try to overcome our weaknesses we won't overcome them; we never experience a victory over them, and so we succumb. 
The negative attitude is intensified by our affluence. In the West nowadays, we don't experience an outer necessity to overcome inner hurdles: we don't have to, so we think we can't. In times of deprivation people have no time to think about their inferiority complexes, anxieties, parents' neglect, or morning grouchiness. When survival is at stake, phobics will enter crowded stores and 
people with unhappy childhoods will hold on to their partners, regardless of all the reasons why they "can't." And their actions prove to them that they can do what they would have thought impossible. Their confidence grows with their experiences, and the unfortunate attitude of"I can't'' has no chance to develop. In this sense the child in the affluent society is disadvantaged, and the percentage of the psychologically sick is correspondingly high. 
The counselor seeks to change the unhealthy attitude of "I cannot because" to the healthy attitude of "I can in spite of." Many psychotherapies concentrate on exploring the reasons why a client "cannot" rather than 
20 
planning a course of action "in spite of" the handicaps. The logotherapist discusses the "cannot reasons" only to find out if factual limitations exist. She then leads the client, gradually and purposefully, toward an attitude of "I don't have to take every nonsense from myself" (Frankl). She supports the clients' defiant power to overcome their weaknesses. The method is usually successful because clients who have at least once experienced that "they can in spite of' are never again the helpless victims ofthe "inescapable" reasons that have held them back. The door is open to the healthy attitude of "I can always change." 
A client casually remarked that she never could pass a certain candy store without indulging in some sweets, and that she didn't even try. I interrupted her in the midst of our session and suggested putting on our coats and walking past that store. We could just as well continue our discussion on the street, I told her, and she could see for herself if she had enough will power to resist the sweet temptations. And she resisted. Since then she walks purposely past that store to prove to herself that indeed she can resist. 
Such an "aha" experience, even if it concerns a relatively insignificant episode, is a turning point. It helps clients develop a new attitude that will prompt them to conquer a weakness or to accept an unchangeable fate courageously. They begin to understand that it is up to them to respond to the opportunities life offers. They have to do the responding -no one will do it for them. When they see that their actions arc not automatic reactions but decisions they themselves have to make, they begin to grow beyond their own, previous selves. 
A mother sought counseling because one of her daughters had serious problems. Her second daughter had been an unwanted child, was raised by her grandparents, later came back to live with her parents, was raped by her father, and then had left the family. This daughter had developed into a healthy, young woman who had a good job and a satisfying relationship with a boy friend. The other daughter had been a wanted child, was raised by loving parents, had not been raped, was given the best educational opportunities, yet was unstable and beset by problems. This is reality as it is not found in psychology textbooks. The theory of long-lasting traumas stands on shaky ground. A person exposed to severe traumas may lead a normal life while someone growing up under positive circumstances may go astray. Every person responds to life in an individual way, influenced by past conditions but also free to defy them. 
This "logotherapeutic credo" can help clients overcome unwanted behavior patterns even if they seem hopelessly fixed. A modification ofattitudes can point the way to how people can take charge of their lives rather than dangle helplessly like puppets on the strings of fate. 
While the specific logotherapeutic techniques put patients back on their feet, attitude modification helps them stand on their feet under all conditions. It strengthens them against being toppled by unexpected blows of fate. All these methods can be combined to accentuate the positive, to orient clients toward meaning, and help them achieve health regardless of the initial causes of their problems. It is important, however, that clients understand and accept the goals of the therapy. 
THE FOLLOW-UP PHASE 
During the follow-up phase the counselor 
has to steer the clients toward a middle course 
between excess stress and excess leisure. 
Logotherapy considers both stress and 
leisure indispensable to mental health. 
Healthy stress is future oriented. It results 
from a reaching out beyond the present self 
toward a self yet to be attained, toward 
meanings to be found, tasks to be accom
plished. Healthy leisure, on the other hand, 
issues from the past; it is relaxation after a job 
well-done, a resting to gather strength before 
taking on the next task. A woman who puts 
all her efforts into achieving a much-desired 
goal will not be bothered by the stress her 
struggle causes and will resent any inter
ference. A man after having concluded an 
important task, relaxes happily warmed by 
the satisfaction it has brought, and will feel 
neither bored nor frustrated. 
But stress and leisure have also unhealthy 
aspects. If patients who have just recovered 
from an illness are released into a situation 
where they are under stress because they feel 
overdemanded, they may experience a re
lapse. If, on the other hand, they are 
underdemanded and allowed too much 
21 
leisure. they may start hyperreflecting again 
about their past problems, how they might 
have been avoided. and reactivate the old 
symptoms. The counselor has no guarantee that her clients are going to be released into ideal situations. They may find their life more stressful than they can handle during their recuperation, or they may be overprotected by a circle ot well-meaning friends and relatives. Logotherapy can strengthen the clients' spiritual muscles, however, to prepare them for the stresses that sooner or later arc bound to come. Logotherapy can also help them acquire life goals that will fill their leisure time. The counselor can accomplish these objectives by helping the clients find individual meaning possibilities and by broadening their base of values. Discovering Individual Meanings For the diagnostic phase I recommended the alternate diagnostic technique to counteract the danger of hyperreflection. During the follow-up phase the counselor can make good use of the additional information she has gained in the previous phases about the clients' preferences and goals. These are the stepping stones on their paths to mental stability and happiness. One thing must be avoided: to discharge clients into a life that has been reduced in meaning opportunities by their sickness, without having found a replacement for the losses. Even psychologically healthy people find it difficult to bear a reduction of their life's contents, especially if they may feel it was their fault. Those recovering from illness will suffer even more. Mrs. S, a mother of two, had been hospitalized in a clinic three times for depression and general exhaustion. Every time she recovered but had a relapse. Before she was discharged the third time I was called in to talk to her. During our entire discussion Mrs. S kept bringing up her children, recounted episodes from their lives, and hardly mentioned any other areas of interest. This was a warning signal for me. I had read in her medical report that the husband had sent the children to a boarding school to provide regular care for them and to relieve his wife from the strain of having the children around. From what Mrs. S had told me, the children had been central 
to her life, and now she would not be able to see them too often. I was afraid that the emptiness of the house and the lack of a task would create an existential vacuum in her. It would have required great strength of will and inner security to build up a new field of activity by herself -more than could be expected from a patient recovering from a depression. I suggested keeping her in the clinic until she had been given time to think about restructuring her life in the absence of her children. But the doctor was convinced she was well enough, and her husband, too, 
urged her to come home. 
Three weeks later Mrs. S was brought back to the clinic. She had taken an overdose of sleeping pills and been saved in the nick of time. She had not been able to stand the stillness and emptiness of the house. Leisure and relaxation, as I had foreseen, had not been sufficient to fill her life with meaning, especially since what had been most meaningful to her in the past had been removed. 
After several sessions it became clear that 
Mrs. S had a fondness for animals second 
only to her love for her children. She 
succeeded in finding a job in the public zoo. 
She enjoyed her new work, and it was 
touching to hear her talk to the animals 
tenderly and watch her care for them indi
vidually. For her children it was a thrill that 
their mother's work gave them free access to 
the zoo, and on weekends they brought 
friends from the boarding school to proudly 
show them "their" zoo where their mother 
helped. One Sunday I went to visit Mrs. Sat 
the zoo and saw from the distance how she 
laughed with the children. I went home 
convinced that the follow-up had been suc
cessful. 
It is evident from many such examples that 
the entire therapy is jeopardized if the patient 
is discharged to a life that lacks meaningful 
content. The follow-up phase requires that 
counselor and client go on a common search 
to discover a variety of ways in which the 
clients can find meanings so they can recon
struct their existence satisfactorily, appraise 
their opportunities, and see the direction they 
wish their life to take. This search also 
provides the best kind of dereflection, at a 
time when it is vital for them to forget their 
sickness and remember it only in terms of 
their achievement -to have overcome it. 
22 
Life offers many meanings but they are often overlooked. The counselor does not create meanings, she merely elucidates them for the clients to see and make them part of their thoughts and actions. The counselor draws the clients' attention to new life contents that may strengthen them and give them new incentives. 
If Mrs. S, deep within, had not loved animals all along, she would not have found the satisfaction in her job that gave new meaning to her life. I did not create her love for animals. I merely helped her uncover it to make her conscious of a potential that was at her disposal. This I was able to do because I had not restricted our discussions to her depressive moods but talked to her as a woman with many healthy attributes that could bring satisfaction to her, and spread them out before her so she could choose one that suited her unique personality. 
To elucidate individual meaning potentials is one of the two preconditions that will help reduce recidivism. The other is a broadening of the base of the client's values. 
Broadening the Base of V aloes 
Some individual meaning goals cannot be realized. Mrs. S, for instance, might not have gotten the job at the zoo, and this would have closed that particular path to meaning. But this failure would not have ended her fondness for animals and for nature in general. No one could have prevented her from keeping a dog, from feeding birds in the winter, or from taking pictures of ducks in a pond. These activities might not have been enough to fill her day but this was not necessary. What she needed was an enrichment of her life, a feeling that she was useful. 
People who see only one value to fill their lives, be it work, family, or material possessions, are in danger of losing that value and succumbing to despair. A variety of values, on the other hand -ideals, hobbies, interests and activities -provides a safety net that will break their "fall from great heights"when one of these values has been lost. 
Logotherapy points out the direct connection between mental health and the broad base of values that fill our lives. Logotherapy, just like behavior therapy, has been accused of merely treating symptoms. A counselor, however, trying to enrich a client's value system, is far removed from treating symptoms. She does not look back for hidden whys and wherefores, for deep-seated disorders, drives, and deviations which have to be dragged into the daylight of consciousness; she pushes forward to the heights ofideas and ideals, she elucidates the forces of the human spirit which alone can assure mental health and productivity in the broadest sense, beyond all treatments of symptoms. Psychoanalytic and logotherapeutic procedures both do more than "merely" treat symptoms, but they clearly differ from e'lch other in two ways: In the direction from which they approach the symptoms, and in the sequence of treating them. Both direction and sequence are important in therapy: the direction for the self-understanding of the client, the sequence for the prevention of subsequent problems. 
Figure 3. Approaches to Symptoms 
In psychoanalysis 
Drives, emotions, Unconscious motivations. cause~ SYMPTOMS 
In logotherapy 
Forces of the human SYMPTOMS ~ prevent ~ spirit, will power, goals, tasks 
The Direction of Approach 
The counselor who, to interpret symptoms, looks for unconscious drives, creates in clients a self-image of dependency: they see themselves as not fully responsible for their actions because these actions are determined by their drives or their past. They get the self-image as persons who are dependent on outside influences. Therapy can make them conscious of these influences and thereby alleviate them, but they still will see themselves as victims of their drives and outside influences. All 
23 
attempts to free themselves seem a hopeless struggle against impenetrable and ungovernable (i.e., unconscious) forces which dominate their lives against their will. Once clients have been steered into this direction it is difficult for them to change course; the approach to their symptoms becomes part of their selfunderstanding and fosters a tendency toward nihilism and fatalism. Their initiative is paraly1cd and their readiness to take charge of their lives is weakened. They will find it difficult to live according to their own values. 
The counselor with a logotherapeutic world view will lead her clients to a different approach. She will help them see a meaningful life, full of goals and tasks that have to be pursued in spite of adverse conditions. They can reach their goals because the powers of their human spirit enable them to take a stand even against their own weaknesses and drives. A counselor following this approach can supply the decisive turn toward mental health. 
The clients' understanding of their person and the world is oriented toward the positive. They see the whole range of possibilities and rcalile that it is up to them to actualize them. The logotherapeutically trained counselor presents a picture of the human being which gives hope and courage -the best gift that can be handed to a client about to be discharged from treatment. 
The Sequence of Treating Symptoms 
The sequence by which the symptoms arc 
reduced is important because each symptom 
causes a chain reaction of consequences 
which, in turn, produce new symptoms. 
Therapy is a race against time; namely, the 
time it takes to cure a symptom before it can 
cause new problems. 
A hysterical condition, for instance, may 
cause a marriage to break up which, in turn, 
may lead to the thought of suicide. This 
simple chain of three links makes it obvious 
that the time available for helping with the 
hysteria is limited to the time the marriage is still intact. and that the marriage counseling which then becomes necessary must conclude 
successfully before suicide appears tempting. 
If the counselor first looks for the causes of hysteria, the marriage may be in ruins before they are unearthed. And by the time the counselor is ready to use her findings to reduce the hysteria, the patient may have committed suicide. A dramatic example, to be sure, but it illustrates the importance ofthe sequence in which the symptoms are treated. The counselor must first attack the dominant symptom, in order to interrupt the fatal chain of events, even if they arc not as drastic potentially as in the above example. Only then the time has come for exploring possible causes or, even more useful, appealing to those forces in the client that are likely to prevent a recurrence of the symptoms. 
In the follow-up phase the best possible advice is to anchor the clients in a broad base of values. It is their responsibility to discover these values. They will be on their way to health if they can draw from a variety of values offered by their profession, family, hobbies, friendships, interests, fulfilling experiences, individual tasks, religious beliefs, and even by sufferings to be overcome. This range of values protects the clients from egocentricity, so widespread today, which leads even healthy people to become asocial and isolated, and which overpowers the sick through the terrible phenomenon of hypcrreflection. Clients who pursue positive values and goals become spiritually alive; they grow beyond their present selves toward inner fulfillment that lies beyond pleasure and pain, and is closer to "happiness" than anything else. 
Not all treatment can conclude on such a note of inner growth, but the best possible advice would be to leave clients with the suggestion that up to their last breath they have the possibility to shape their life, responsibly, and filled with meaning. 
REFERENCES: 
I. frank!. Viktor E. "'Zur mcdikamcntoscn Unterstiitzung der Psychothcrapie bei Neurosen." Schwei7cr Archi, fur Neurologie und Psychiatrie. 1939, 43, 26-31. 
2. ________. Mans Searchfor Meaning. 
Paper back edition, New York, Pocket Books, 1977. 
24 
Modification of Attitudes 
A modification ofattitudes is an important step in the logotherapy program. especially when clients find themselves in situations that are void of meaning yet cannot be changed -"blows of fate," accidents, incurable disease, the irrevocable ending of a relationship. a career, a life. It is possible and therapeutic to find a meaningful attitude toward a situation which in itself is meaningless. 
Modification is also therapeutic for attitudes that are negative. destructive, or reductiomst1c. The therapist does not decide whether an attitude is "correct" or "moral," but whether it is healthy. Often, common sense will serve as a guideline. 
Negative attitudes are indicated in remarks like these: "There's no point in my trying, things always go wrong with me." or "I don't want to have anything to do with people, they are all beasts." An unhealthy attitude may be suspected when a mother says: "I've got to take care ofmy children, or the juvenile courts will breathe down my neck," or if a wife declares. "My husband and I live our own lives, but that's all right, no one interferes with the other." Therapists cannot "prescribe" different attitudes but must he able to tune in on the underlying message. If an unhealthy attitude is apparent, the therapist dares to question it and help the clients see that they have other choices. 
A modification of attitudes may not always succeed but must be attempted. Sometimes a remnant of the healthy argumentation is left in the unconscious mind of the client and emerges during an acute crisis situation. 
Steve had a severe and incurable speech 
defect. He avoided young women because he 
was afraid they would laugh at him. All my 
attempts at changing his attitude failed. I 
suggested that women who made fun of him 
were not mature enough to make good 
partners, but he said he didn't give a damn 
about their maturity, he just wanted to dance 
and have fun like his friends. I challenged him 
to go to a discotheque where the noise would drown out his speech defect, and I argued that "the worth of a person does not depend on how well one speaks," but he rejected this too. We discussed other ideas as, for instance, to make friends with a woman who was in some way handicapped herself, but he refused "to 
take what no one else wanted." 
His self-defeating attitude gradually extended to other areas and blocked all therapeutic cooperation. We decided to interrupt the counseling for half a year. Before that time was up, I received an urgent call from a clinic. Steve had been brought in after a suicide attempt and asked for me. 
After some drinks, and alone in his apartment, Steve had cut his artery. Seeing his blood gush out, he apparently had sobered up enough to call the emergency. When the doctor arrived in his apartment, Steve was barely conscious and repeated over and over again: "The worth...of a pcrson ... does not depend ... on how one speaks." 
My logotherapeutic argurr,entation which 
he had rejected months ago, had proved 
stronger in the decisive moment of a crisis, 
than his despair and resignation. 
The case touched me deeply. Steve had 
matured through his experience. He had 
struggled with himself and ultimately said 
"yes" to life. He stuck to his decision. After 
this incident he was open to the Socratic 
dialogue without the constant resistance of a 
"yes-but" attitude. 
Therapists are here not to judge whether an 
attitude is good or bad hut to use their 
knowledge, experience and intuition to decide 
when a client in a certain situation is dis
playing an attitude that is harmful, unhealthy, 
or possibly dangerous and destructive. The 
logotherapist is on guard as soon as the 
dialogue reveals attitudes of negative de
terminism, and does not shy away from 
openly discussing them. Herc she goes beyond 
the client-oriented counselor who helps the 
client see himself through mirroring. She 
goes far beyond the behavior therapist who 
disregards subjective variables as much as 
25 
possible and concentrates on quantifiable reaction patterns. And she goes in the direction opposite that of a psychoanalyst who uncovers psychological repressions without paying attention to attitudes or cognitive feedback reactions. 
The Bad-Parents Complex 
But cognitive feedback reactions cannot be ignored, and they often manifest themselves in physical symptoms. These connections were apparent in the case of 21-year-old Inge who was sent to me by an abortion clinic for a routine psychological authorization. Inge came to me with drooping shoulders, lowered eyes, her feet dragging. She hardly dared to take off her coat, finally sat down on the edge of a chair and began to stammer, her perspiring hands in constant motion. She wanted the abortion because bringing up a child was beyond her; she felt insecure and afraid of the future. 
I listened patiently. I wanted her to relax and learn to trust me. I turned on the soft light of a floor lamp and took no notes, to avoid irritating her. Gradually she lifted her head, made eye contact occasionally, and spoke more fluently. After half an hour she made a statement to which I have become highly allergic because it betrays an unhealthy, deterministic attitude. "My parents never let me take care of my own affairs. They always made the decisions for me, and now that I am grown-up I don't know what to do. They still see me as a little girl, and I have always followed their advice. And now I cannot make up my mind because no one tells me what to do. It's all my parents' fault." 
This is a widely held unhealthy attitude. Of course, it was possible that her parents dominated and protected her too much. But if she now, as a grown woman, could not free herself from this dependency, if she considered herself as hopelessly incapable of making her own decisions, if she herself saw no chance to liberate herself from her childlike attitude, then she had no chance. She was stuck and would not be much more mature at the age of 50 because her fixed attitude had choked off her maturing. And the physical symptoms were the telltale signs: the lowered eyes, the perspiring hands, her erratic movements, this entire hyponeurotic reaction pattern was the result of her unhealthy attitude. 
This, then, was the critical point when I no longer could listen passively, when I felt challenged to open her eyes in a Socratic dialogue, along with the following lines: You claim your upbringing made you dependent and helpless. Do you want us to use our time together to support this dependency and helplessness, so they influence your life more and more? If you wish, we can talk about your dependency, we can look for its roots, and you will become increasingly aware of your helplessness the more clearly you'll see the causes. You may decide to have the abortion which will confirm your conviction that you are not able to master the tasks of your life, that you are indeed a failure. I wonder what your life will be like if you keep avoiding the difficult tasks because you feel you can't handle them? 
Inge sat a long time, thinking. "I don't want to be a failure forever," she finally said. "What shall I do?" 
We talked for two more hours, without perspiring hands and without lowered eyes. "Why did your parents overprotect you?" I asked her, and she had to admit that it was because they loved her. "Ifyou were raised by parents who loved you," I said, "then you have a good basis for your own behavior. You, too, can love, and love is the first thing your baby will need if you decide to have it. The next thing you need is the strength to take on responsibility -for yourself and for those in your care. You cannot blame your unwillingness to take on responsibility on your childhood or your parents, without a feeling of discomfort and failure. Every time you do make a responsible decision, your capacity is strengthened to carry it out. If you make an "easy" decision because it seems most comfortable at the moment, it will weigh on you later on." In this vein I tried to mobilize Inge's resources of the human spirit and fortify her self-confidence. In the end I handed her the certificate authorizing the abortion and placed the decision in her hands. 
A few days later she returned and said she had thought everything over and decided to have the baby. For the next three months I gave her some assertiveness training, and this was followed by discussing her future plans. When we concluded the counseling, her attitude toward life had changed; she was serene, confident, and looked forward to 
26 
having her child. 
The "bad-parents complex" often is behind unhealthy attitudes. For years, psychologists have been looking for mistakes made by parents. Parents have been blamed for being too authoritarian, too indifferent, too critical, too success-oriented, not enough democratic, too unsure, too inconsistent -until many parents indeed became unsure of themselves and for that reason alone committed mistakes. Contributing factors were the crumbling of traditions and the mass of contradictory pedagogic literature. Parents have become the favorite target to be blamed for their children's failures, and it is no wonder that the young people themselves all too readily point the finger at the parents to explain their own weaknesses. 
Undoubtedly parents do make mistakes in bringing up their children. Also, the increasing numbers of working mothers cause an additional strain on the family. But a large percentage of parents lovingly care for their children, bring sacrifices, and do their best to prepare them for the future. Their affectionate concern cannot simply be swept aside, while paying attention to only those moments when they lose their nerves or fail to find the right word at the right moment. 
True, it has been proved that clients arc helped when they see connections between their development and their upbringing. But it has been proved as well that such a looking back may set in motion a feedback process which reduces their sense of responsibility for their actions. They are prone to say: "I cannot act differently, this is the way I have been shaped," and this attitude blocks the paths to further growth and maturity. Ego strengthening is not enough, what is needed is a vital process of self-discovery, not only in terms of who they arc but also in terms of who they still can become. And this process requires recognition of their own responsibility. 
Admittedly, each person is equipped from 
the start with different gifts, some amply, 
others poorly. But whatever the base, the 
young must build on it. A part of their success 
is up to them alone; they can fail in spite of 
rich natural gifts, and they can succeed in 
spite of poor ones. Young people have to be 
made aware that their course is not set once 
and for all, that they can give their lives a direction, toward the positive as well as the negative. 
The Unwanted Adult 
Psychotherapy can explain human failure but must not serve to excuse it. An unhappy life may be the consequence of an unhappy childhood, but is not its inevitable result. An unwanted child is not destined to become an unwanted adult. An honest poll probably would show that a large percentage of children were not truly wanted and planned by both their parents. Can we assume that these children were secretly loved less because they were not fervently desired during pregnancy? Can a parent's love not grow during that time? Can a mother not accept her child with joy even if she had doubts before its birth? It is risky for a mother to admit to a psychologist that the child was originally not planned or wanted. He may be inclined to condemn her however she treats the child. If she is cool and controlled in its upbringing, he might say she rejects the child because it was unwanted. If she is warm and caring, he might suspect that she unconsciously hates the child and overcompensates to hide her repressed feelings. Whatever the mother (or the father) does, the child cannot develop to perfection, at least not in the opinion of psychologists with such an orientation. 
Suppose the mother conceived the child against her will and deep inside really rejects it. And suppose further that as compensation she is especially loving to the child. This has to be acknowledged as a grandiose achievement by the mother who does not want the child to know that it was born against her wishes. The mother takes a stand against her own inner rejection of the child, to spare the child suffering. There is heroism in such a stand. One becomes a mother not by anticipating a child with great joy but mostly by loving the child in spite ofall difficulties. It is destructive reductionism to say that the achievement of such mother love is "nothing but" a compensation for an inner aggressive drive. 
Mrs. A came to me because of difficulties with her teenage daughter Janie. When Janie was a child, Mrs. A had played and exercised with her. Doing a somersault, Janie had hurt her spine and suffered pain for many years. After extensive treatments Janie was completely well but Mrs. A had developed a 
27 
phobia about her. She could not bear seeing the girl ride a bike, and broke out in sweat when Janie came home from school a few minutes late. Her husband and Janie both laughed about her fears, and Janie became completely unmanageable. 
Mrs. A had been in psychoanalysis for almost two years but her phobia had not lessened. When she had asked the therapist to help her with her problems with Janie, he had replied that he did not deal with problems of child-rearing and so she had turned to our counseling center. Sadly she said: "He never helped me with Janie. He kept asking me about my childhood. For hours I had to tell him about the past. When I asked him what to do about Janie, he said that I had to know that myself, and when I would no longer be sick I would know. That meant to me that I am still sick because I often don't know what to do about Janie. I don't have the money for therapy twice a week, and so I resigned myself as being not quite normal. But I don't want to do more harm to my child, and so I ask you to tell me what I have done wrong in raising Janie." 
I first explained to Mrs. A that we could 
not separate her "sickness" and her peda
gogical problems because both were triggered 
by her excessive anxiety about Janie. But she 
need not accept her anxiety as permanent; it 
was not her"normal"condition but rather the 
result of the unfortunate accident. Just as 
Janie had physically overcome the accident, 
so Mrs. A could overcome it psychologically. 
Paradoxical intention which ordinarily is 
helpful for phobias could not be used in this 
case because it was difficult to find formula
tions the mother could be expected to intend 
paradoxically (as, for instance, 'I wish Janie 
would hurt herself badly"). I therefore 
worked exclusively with a modification of 
attitudes. I told Mrs. A that although she was 
terribly worried about Janie's health she did 
not need to act according to her worried state. 
She was free in her actions and also could take 
a stand against her anxiety. She could decide 
to let her daughter go bicycling and at home 
suffer from her worries while telling herself: "I 
sent her bicycling in spite of my anxiety!" 
And -an important point-she could be proud 
of her action because to "boycott" her anxiety 
is an achievement, all the more so the greater 
the anxiety. She could point out to her 
husband and daughter that she had made her decision in spite of her neurosis, which they would have to acknowledge -there was no more cause for ridicule. I also tried to appeal to her mother love by saying that children learn from the example of their parents, and there was the danger that Janie might transfer the anxiety she saw in her mother to her own future behavior patterns. It might make a difference in Janie's life to see that anxiety need not immobilize people, but that one can act sensibly in spite of strong emotions. 
Mrs. A was receptive to my arguments, and after several sessions herself suggested the following: Janie's greatest wish was to learn to ride a horse, but Mrs. A had violently objected although her husband sided with Janie. Now she had decided to surprise her daughter and drive her to a riding school to inquire about the conditions. She said: "I know I'll be sick at the thought ofJanie's sitting on a horse which could run away and throw her off. And I won't pretend to Janie that I'll feel all right about it, but she should know that my love for her is stronger than my fear. But I have a question that has been on my mind for a long time. You see, my psychiatrist interpreted my fears about Janie as a deep-seated and repressed wish for Janie's death. All my fears, he said, were a symbol of an inner aggression against Janie. And this thought depressed me more than my sickness, it's so terrible! ls it possible that deep inside I really hate my child, that this is the reason I caused her injury? Am I really so evil? 0 Lord, can it be true?" 
Such situations always present a dilemma for me because to contradict another therapist undermines the client's trust toward all. But in this case it was absolutely necessary to sweep away all doubts about her motherly feelings, and to strengthen her trust in herself. Instead of curing a phobia, the therapist had added an iatrogenic neurosis which I tried to counteract with positive-oriented arguments: 
"I am certainly not all-knowing and cannot see what goes on in the depth of your unconscious, but the one thing I have heard from all your words is your genuine affection for your family, and especially for your daughter. Your playing and exercising with your daughter a few years ago was done out of love. The accident was truly that -an accident. Janie could have hurt her spine just 
28 
playing in a playground. Your suffering and worries afterwards are also proof of how much you love Janie. Not hate is the opposite of love but indifference, and nobody will be able to convince you that you are indifferent to Janie. But the greatest proof of your love was your suggestion today, to drive Janie to a riding school. Only someone who knows the tortures of the human soul will be able to appreciate what the suggestion meant to you; 
it is the victory of love over your fear! No 
further proofs are necessary for you to know 
that my colleague was mistaken; his mistake is 
as obvious as your love for Janie. You must 
not be too harsh on psychology for making 
mistakes. It is a young science. When the
J 
natural sciences were as young as psychology 
is today, scientists still were convinced that 
the earth was a disk floating on the ocean and 
that Apollo was driving across the sky like a 
chariot..." 
At that, Mrs. A broke into a relieved laugh 
and declared happily that she would bury the 
thought of hating Janie for all times -she 
never really was able to believe it. 
Janie received her riding lessons, and Mrs. A was able to reduce a large part of her fears. Their relationship improved as I explained to Janie what it had meant for her mother to overcome her fears and let Janie lead a normal and healthy life. The youngster appreciated her mother's self-control, and what was equally important, Mr. A began to believe once more in his wife's gradual recovery and supported her in her efforts. From time to time Mrs. A suffers from attacks of anxiety, but she can handle them and is increasingly confident that they will improve because she herself now can believe in her eventual complete recovery. 
Distancing from Symptoms 
Modification of attitudes is the second of 
the four steps in the logotherapeutic treatment 
plan. I The sequence of this plan may be 
changed as the situation requires. 
Ordinarily, this first step, distancing, pre
pares the patients to gain distance from their 
symptoms, to become more objective. This is 
followed by a modification of attitudes, 
helping to reduce their symptoms. The last 
step then is an orientation toward meaningful 
activities and experiences. 
As long as clients identify themselves with 
their symptoms, it is difficult for them to gain 
a new self-understanding. As long as they see themselves as sick, they are sick. If they consider help impossible, help is impossible. Ifthey think of themselves as victims of their childhood experiences, they are victims. Obsessive compulsive patients really believe they are under a compulsion, phobics really see themselves as excessively in danger, stutterers are certain not to be able to speak fluently, sexual neurotics really see themselves as impotent, failing students really consider themselves as stupid, depressive patients really believe they are destined to be sad, and patients suffering from paranoia really feel they are being attacked and observed. 
The therapist seeks first to combat the identification of a patient with the symptoms presented. Mrs. P came to the center because she was, as she stated, unable to respond sexually to her second husband due to the brutal treatment she had received from her first husband. As long as she was in the grip of her own hypothesis, as long as she said, "I am frigid, I am unable to love because ... " no cure was likely because nothing could be done to change what had happened between her and her first husband. She was enmeshed in her dependency, felt determined by her trauma, and identified with her symptom. 
It was my task to liberate her from her unfortunate hypothesis that she was frigid, and to show her that she was a woman who had a problem with frigidity, that frigidity was something she had acquired and again could get rid of. My arguments went like this: "The experience with your first husband is no reason why you cannot love your second one. There is no connection between these two men, they are different people, meeting you at different times of your life. You yourself are not the same person you were during your first marriage. You love your present husband and want to give him your love, otherwise you wouldn't have come to me. It is an unfortunate experience, a bad memory that fills your head and causes all sorts of mischief. In reality you are able to love your husband with all your heart, with all your will, with your whole person. We won't empower that unfortunate memory, we won't let it destroy your happiness. If that memory turns up again, speak to it. Tell it: 'Oh, it's you again? Well, I know you well enough by now, you are 
29 
no longer as interesting to me as you once were, why don't you go back where you came from; namely, to the past where you belong! I now have more important things to do than worry about you.' If you think along these lines, the hold of old memories will weaken and your inner strength will become free so you can turn your attention to your present happy situation." 
This is essential in the logotherapeutic process: patients are encouraged to speak freely about their innermost hopes and fears, but when they voice harmful explanations which they have pieced together, the time for logotherapeutic action has come. Dependencies have to be loosened, even when the therapist can well understand them. Only after the clients have been liberated from their pathogenic hypothesis of dependency can they turn to a new and healthy attitude that 
can counteract their symptoms. They must be freed from the grip of their psychological illness, a distance must be placed between the self and the symptoms. Never again the declaration: "I am fearful," Instead, they go on to say: "Here I am, well and normal -and over there is a ridiculous fear that sometimes wants to grab me. but I'11 show this fear who is the master!" The defiant power of the human spirit is aroused to bring about the necessary self-distancing. 
The Search for Healthy Attitudes 
The liberation of the clients from their 
belief in a dependency brings enormous relief. 
Phobics who realize that they are not the 
hopeless victims of their fears and can even 
laugh about them, and young adults who 
realize that parental overprotection does not 
prevent them from taking charge of their life 
themselves, are ready for the second step in 
their treatment: the search for a new and 
healthier attitude. 
An attitude is healthy if it directs clients 
toward goals that are meaningful for them, or 
at least keeps the path open toward such 
goals. An attitude is unhealthy if it promotes 
an existential frustration (as in the case of 
Steve who avoided women because of his 
speech defect) or if it undermines the will to 
make decisions (as in the case of Inge who 
believed her upbringing had weakened her 
ability to take charge of her life). 
Ordinarily, the modification of attitudes 
follows directly upon the distancing ofpatient from symptoms. In the case of Mrs. P, tor instance, I led her to see that her unfortunate experiences in her first marriage had positive potentials because they could help her appreciate her happiness in her second marriage more intensively. I talked to her, during the next several sessions, along these lines: "Just because you have gone through marital suffering in the past you now can appreciate your present husband and be a much better wife than many others who jeopardize their marriage frivolously with petty quarrels because they do not know yet how brutal an unhappy union can be." I tried to effect a change in attitude from "I no longer can truly love" to the attitude of "I can love my husband all the more because I already know a different version of a marriage." Once this change in attitude had occurred, Mrs. P became sexually responsive. She had gained a new understanding of herself and of her capacity to love her husband for an added reason, and this enabled her to overcome her physical block as a natural outcome of the depth of her feelings for him. We reached the third step, the reduction of symptoms, although the symptoms had not especially been treated. 
Thomas Edison is quoted as having said: "That's the beauty in making a mistake, because you do not have to make it a second time." Implied in this sentence is the possibility to decide freely in spite of all mistakes one has made because of genetic make-up, faulty learning, and social influences. The logothcrapist guides the client toward an attitude of "I don't have to." Even if I have made a mistake twenty times, I don't have to make it a twenty-first time. Even if a psychological disturbance has taken place every day, it doesn't have to take place tomorrow. Undoubtedly, every failure increases the probability for further failures, and yet there remains the chance that a person finds enough strength to defy this probability. This "you don't have to" is the "therapeutic credo" of logotherapy that is transmitted to the client. 
Peter, 18 years old, was referred to our 
counseling center by the juvenile court. He 
was the illegitimate child ofa woman who had 
ten other children from various fathers. Peter 
was raised by a number of relatives and foster 
parents in vastly differing styles of upbringing, 
had never known continuity, security, and 
30 
daily routines. Drunken and violent men made their appearance, and often the child was snatched out of bed in the middle of the night and hidden in a cellar where he sometimes was "forgotten" for awhile. Finally he found foster parents who tried their best but had great trouble with him. They compared his erratic behavior and poor performance in school with those of their own children. Twice he ran away, got caught for minor offenses like shoplifting, damaging property, stealing bicycles. After he failed in three jobs, his foster parents repudiated him, and from then on he went downhill. By the time he came to me he had quit or been fired from thirteen jobs, and he was depressed and rebellious, convinced he was not able to hold any job. 
All this background was contained in a thick file the juvenile court had sent me with the request to decide what chances I still could see for Peter. The facts contained in the file would have justified the judgment that there was no hope. Nevertheless, I challenged the young man. I told him that his record justified the doubt that he could straighten out, and even he himself had given up. But, I added, I was not prepared to give him up. I would close the file in front of his eyes and would forget everything I had read in it. We would start all over again, as if all the opportunities of life were still going to be open to him. He had never learned constancy, 
reliability, or endurance in his childhood, so it was time to learn them by himself. He would learn these qualities out of his own experiences, and his failures were the "tuition" he had to pay for life's lessons. Other people learn from education or the example of their parents; he would learn from ten or twenty unsuccessful attempts. When ready to graduate from this "education through failures" school he would value the importance of sticking it out and "enter life" as any other graduate. He would have to put out a serious effort to make a new start and this time he would succeed. 
Peter listened with interest because this was the first time that someone expressed confidence in him and expected him to succeed. He started as a helper in a toy store, with good intentions, but was too clumsy and lost his job. That was his fourteenth attempt. After the seventeenth he was ready to give up and only after great effort was I able to persuade him to try once more. He had to unload cars for a florist, deliver flowers, and occasionally was allowed to help with the gardening. One year later he is still there and was given the opportunity to become an apprentice. He is proud of his achievement and goes to an evening school to make up some of his missed-out high-school courses. To vary Edison's statement: "That's the beauty in making a mistake, because you do not have to repeat it eighteen times!" 
Attitudes in the Tragic Triad 
In cases of what Frankl has called the "tragic triad" (unavoidable suffering, inerasable guilt, and death) it is not possible to attain the first and third steps of logotherapy procedure. No one can attain distance from the "symptoms" of suffering, guilt and death, nor can these be eliminated. In such cases the other two steps, modification of attitudes and orientation toward meaning, are all the more important. 
Mrs. M was desperate because her eightyear-old son Walter was so hypersensitive to pain that it was impossible to live with him. When his baby tooth was loose he could not brush his teeth; when his bath was a trifle cold he could not stay in; the smallest scratch became a tragedy. A medical examination showed that Walter was suffering from dermographia, a somatically conditioned oversensitivity which might improve in later years but had to be accepted at least during his childhood. To find a starting point for a modification of attitudes (without hope of changing the symptoms), I explored the daily routine of the child, and discovered that Walter was unusually musical, was praised by 
his music teacher for his absolute pitch, and even had participated in concerts. The mother was proud of his talent. 
Here was the opportunity to try a modification ofattitudes. I led Mrs. M to perceive that life had offered an alternative to Walter: either absolute pitch requiring a delicate acoustic sensitivity but also a similarly delicate sensitivity in other areas, or no such musical talents, no musical ear but also no sensitivity; instead, a robust stability. Mrs. M could perceive her son's sensitivity to pain as a price he had to pay for being a musical genius. She even found a healthy way to handle Walter's sensitivity. Whenever he cried about 
31 
minor pains she started to sing and asked him to sing along and thus"dereflected" him toward something positive. This also reduced her anger at Walter's oversensitivity because her new attitude allowed her to concentrate on some positive aspects in her child. 
A Greeting from the Grave 
The following case illustrates how a modification of attitudes was achieved in an emergency situation, and also how an unfortunate coincidence can become the "logohook" for finding a treatment plan which up to then had eluded discovery. 
Hilde M, 55, suffered from endogenous depressions which had started several years back, after one of her daughters had been in a car accident and died seven weeks later without ever regaining consciousness. The other three children had grown up and moved away, and Hilde felt useless. 
One day she called me in utter despair and confusion. I could not understand her stammering and I asked her to come to see me immediately. 
Trembling and choking with tears she told me the following: Today was her birthday. None of her children was with her and she had gone to her mailbox to see if anyone had remembered her. She found only one letter, addressed to her dead child, sent from the hospital where her daughter had died. Mrs. M considered it as "a mockery of fate" that this letter had reached her on her birthday, to remind her of her tragedy. She was in shock, completely devastated, and I put her down on a couch, trying to calm her. 
Eventually I took the unopened letter from her perspiring hands and found it a routine request by a young doctor working on a dissertation about collarbone fractures. He had seen from the hospital files that Mrs. M's daughter had suffered such a fracture, and failed to notice that sht: had died. The letter contained questions about the consequences of the fracture. But my explanations only upset Mrs. M even more. She said that God Himself must have wanted to punish her by letting this letter show up in her mailbox on her birthday. This interpretation encouraged me to try for a modification ofattitudes along her own way of thinking. "God may have intervened, as you suggest, but in a different way than you think. Isn't it possible that He has chosen this way for you to receive a greeting from your dead daughter? We'11 send back the letter with an explanation, but you keep the envelope. Your daughter's name is on it, and it came on your birthday. It's like a birthday wish. Your other three children live their own lives, they hardly have time for their mother's birthday, but this child has no opportunity to congratulate her mother. Through this coincidence she has become alive again in your thoughts and your heart -isn't it like a miracle? I don't think that fate wanted to torment you through this mistake of the doctor -you have suffered enough. Perhaps fate wanted to comfort you by playing this memory into your hands, just on your birthday -it's like a gentle greeting from your daughter. .. " 
Mrs. M sat very quietly, for a long time. Then she placed the envelope carefully into her handbag, stood up, pressed my hand, and left. 
Somehow she was now able to bear her pain because the misdirected letter had taken on a meaning which was acceptable to her within her expressed values. The unhealthy attitude, her belief that everything had conspired against her had given way to the perception ofa symbol ofdaughterly love that had reached her from beyond the grave. 
To the wellknown saying, "Every crisis has its challenge" could be added another one: "Every suffering has its meaning." The meaning does not lie in the suffering itself but can be attained by one's attitude toward it. It is not easy to find a meaningful attitude toward a suffering which in itself is meaningless, but if the therapist succeeds in helping the client find it, she can be certain that the client will not be destroyed by the suffering. 
The logotherapeutic modification of attitudes differs from most patient-centered psychotechniques in which the therapist remains relatively passive and, by quiet listening, understanding, or mirroring, creates situations that will encourage the clients to reveal themselves. The logotherapist actively participates in the dialogue and even offers healthy opposition where necessary. She will say "no" to the oppressive compulsive: "No, you will not do what you are afraid of, your very fear guarantees that." She will say "no" to the depressed patient: "No, it is not true that your life has no meaning, and I'll help you find it." An expression of understanding 
32 
or a mirroring may enmesh the client into his problem more deeply. Ifa client states that he no longer enjoys his life, a logotherapist will not say: "I understand that very well after all you have gone through" (understanding), or "You mean you don't want to go on living, you want to die?"(mirroring), but she will say: "And what about the tasks, out there in life. that arc still waiting for you?" 
Logotherapy is education to responsibility not only for the patient but also for the therapist. It is the responsibility of the therapist to pull the patients out from their existential vacuum and point toward a meaningful existence. It is her responsibility to say "no" to patients who feel dependent on unfortunate determinants which hinder their personal development. A physician too has the responsibility to say "no" to a fatty diet if his patient suffers from a gall ailment. It is not sufficient to ask him: "So you like to eat fatty food?" 
"Naive question asking" 
There is, however, an exception to this rule of using the logotherapeutic dialogue as a challenge to the client. Some clients come to the therapist not primarily to seek counseling but to unburden themselves of their worries and to find validation. If the therapist does not provide this validation, or is not ready to listen quietly, the clients may become aggressive and oppose whatever the therapist suggests. Cooperation between therapist and patient then becomes even more difficult. For such cases I have developed the "naive questioning" technique. Here the clients' rebellious attitude toward all advice is used by seemingly supporting their negative and unhealthy ideas and then challenging them to rebel against their own attitudes. This method often leads to an "aha" experience and a turnabout in their point of view. With more sophisticated clients one can put it on a little thick to make them see that unhealthy attitudes often appear ridiculous. They will get the point and move away from their own negative, now slightly exaggerated attitudes. Other more simpleminded clients, like the mother in the case below, don't even notice what the therapist is aiming at. The outcome is the same: guided by the therapist, they reject their own unhealthy viewpoint because, deep within, they know it is unhealthy. This method combines elements of paradoxical 
intention, grains of their own innate wisdom, a bit of humor, a dose of human understanding~making it a truly logotherapeutic composition. 
Marie was a widow with an eight-year-old boy, Roland. This child had great difficulties in school, repeated first grade, and was about to be sent to a special school for emotionally handicapped children. Marie spent every afternoon with him, helping him with his homework, giving him extra spelling exercises although the boy developed fits oftemper and tried to conceal his homework. Marie came to me bristling with arguments, mainly against the oft-heard advice to allow her son more leisure time. 
Fragments of the dialogue: 
Marie: I only want what is best for my Roland. Some day he'll realize that a boy must do his lessons, it's for his own good. What will happent to him if he has to go to a special school? Who'll give him a job after that? What kinds of classmates will he meet there? 
Lukas: Yes, I can understand this. Your concern about Roland shows me that you are a real mother, the way a mother should be. 
M: I can't just sit back and watch him fail. He has to study. 
L: You are thinking of his happiness. 
M: Yes, his happiness is all I want. 
L (after a pause): Tell me, how was it in your own childhood? Did schoolwork come easily? 
M: Well, not really. Especially spelling was difficult. but I had to learn it anyway. All those dictation exercises ... it still gives me the shivers to think about it. 
L: Did they give you so many dictation exercises in school? 
M: No, but my mother did. She was very strict, always ready with the ruler. She always said: sit down and work! Not like the children today who spend hours in front of TV..that didn't even exist then. 
L: So your mother was strict. Did she restrict your play time? 
M: Restrict? I didn't know what free time was! My mother was an ambitious woman; she wanted me to become a nurse, or even a teacher. She had lots of plans for me. Oh well, so I became a housewife and a mother. She meant well, my mother did. She had her definite 
33 
ideas, and no fooling around. Right after school it was dictation, dictation, dictation. 
L (naive therapeutic question): That must have been very pleasant for you? M (surprised): Pleasant? How come? No, 
no! What do you mean? 
L (naive): Well, ljustthought, because you are doing something like this with Roland, and I know you want him to have a happy childhood. 
M: You mean, I'm acting like my mother did? Yes, but he's a boy. He has to become something. 
L: Tell me, what was the happiest period in your life? 
M: Well...as I think about it, that was the time when I was newly married. I had no child yet, had moved away from my parents, my husband let me manage the household in my own way. I didn't know much but I learned from experience, and if something went wrong I tried again. That was the time, I think, when I really grew up and knew what I wanted. Yes, that was the best time of my life! 
L (naive): Then I guess Roland will have to wait a few years until he experiences the best time of his life? 
M: 
Roland? Do you really think he feels the way I did as a child? 

L (naive): Well, I don't know. You know him better than I do. Maybe he feels different than you did. Maybe he enjoys your helping him with his homework. Maybe he doesn't care to !earn from experience the way you did as a young woman. 

M: 
No, no! That's right, the boy is exactly like me! I'm sure he hates my strictness ... (scared) Do you think I'm like my mother? 

L (naive): Oh, that couldn't be. You want Roland to be happy but from what you said about your mother, she didn't really make you happy. 

M: 
Yes, I want him to be happy, but I wonder how he feels about it? Maybe I'm making him unhappy while I'm doing what I think is best for him. I'm all mixed up now. Is it possible that Roland has been unhappy all along? That he'll be happy only after he's moved away from me? (Sobbing) Oh God, oh God! 


L: Lots of young women make the same mistakes their parents did. They have no example to follow except the example of their parents, and the pattern is passed on from generation to generation. Ifyou put Roland under such pressure, with no opportunity for him to think for himself, he may do the same with his children, and this will go on and on. Someone, at some point, must break the chain. I really think you can do it. With a little help from us here and with all the love you feel for your son, you could become a first-rate mother so that Roland later will say: My happiest time was my childhood at home. My father was gone, but my mother -she was my best companion! 
M: I'd like that, Frau Doktor, yes, I'd like that very much. Please help me! 
After this change of attitude, the mother was open to a therapy program ofencouragement and reinforcement, and we acted out the homework situation in psychodrama. Roland's ability to concentrate improved considerably and the repressed boy became a lively youngster. 
The naive questioning technique differs radically from the discussion techniques of other therapies. In the above example, the question "That must have been very pleasant for you?" was the starting point. Rogers' nondirective therapy would have worded the question: "Your mother really put a lot of pressure on you" ( mirroring). Psychoanalysis would have gone into childhood memories (perhaps Oedipus complex). Behavior therapy would have blocked out the past, drawn a base line, agreed on a therapy goal, and suggested a step-by-step procedure, starting out with the assumption that present demands were too heavy. Although this was true in Marie's case, it would not have worked without the logotherapeutic approach which helped Marie change her attitude. Once that had occurred, a form of behavior therapy could be launched, but first her confidence in Roland's abilities, the acceptance of his weaknesses, and her trust in his future development had to be strengthened. The question, "that must have been very pleasant for you?" was an appeal to the defiant power of her human spirit to take a stand and make a decision on her own. 
34 
Modification of attitudes is best accomplished in three phases: First, a distancing from the symptoms; second, a moving away from negative attitudes; and third, the acceptance of positive ones. The therapy program leads clients step by step from self-centeredness to self-transcendence. Identification with their symptoms locks them into selfcenteredness. Excessive attention to negative factors blocks their view beyond themselves. Only when they have broken through the shells of their self-centeredness and the barriers ofthe negative factors are they able to see the positive factors in new meaningful activities and experience beyond themselves, and thus the way is open to a healing process. 
The Viennese philosopher Leo Gabriel said: "The animal is the world, the human being has the world." To "have" the world means to be able to find one's own attitude toward the world. To be able to change one's attitude is a specifically human quality, not available in the physio-psychological dimension: it is a quality of the human spirit. 
REFERENCES: 
1. Lukas, Elisabeth. "The Four Steps of Logotherapy," in Logotherapy in Action, Joseph Fabry, Reuven Bulka, and William Sahakian, eds. New York, Jason Aronson, 
1979. 
The Meaning of Children's Play 
The meaning of children's play may be an activity that allows them to be creative or skillful, or an experience they can share with others or in some way relate to their lives. 
Toy manufacturers tend to produce games that provide little opportunity for children to find meaning: dogs that bark at the push of a button, battleships that sink an enemy, race tracks for fancy toy cars that chase each other in circles, space creatures that can be taken apart and put together again. These toys provide fun but are soon forgotten. How much more lasting is the interest ofa child in a simple boat carved from a branch and floated in a pond. The child knew what the carving was for, it had a goal in view, and found satisfaction in having accomplished a selfchosen task. 
Children at play are often as alienated from meaning as their parents are alienated from meaning in their work. They feel bored and rebel and become destructive -on the toys, on things in the home, school, neighborhood, and on other people. A German magazine featured an article, "What to do when children hit parents." A professor of psychology advised the threatened parent: "Quickly hand the child a vase and let him smash it against the wall. That will abreact his aggression." 
Such advice is based on the concept of the human being as a reservoir of pent-up emotions which have to be released at any price when the dam is threatening to burst. This concept of the human being completely disregards the dimension of the spirit and reduces the person to a helpless bundle of repressed drives. 
In our counseling center we tried an experiment with six extremely aggressive children who caused their parents great worries. These children slit open the belly of a new teddy bear, tore off the leg ofa doll, scribbled and crumpled up the pages of an illustrated book, let air out of balls, smashed toy cars -children who simply did not know how to play but only how to destroy and throw away the ruined toy. 
We asked the parents to collect the pieces of the broken toys and bring them along to the first session. To the children we suggested a plan: they were to make their own toys from the heap ofthe discarded pieces. They were to put together something new. complete, and beautiful, and this was to be done in cooperation of them all. 
The children were asked to contribute ideas 
because the toys were not simply to be 
repaired but to be rearranged in a new 
35 
Modification of attitudes is best accomplished in three phases: First, a distancing from the symptoms; second, a moving away from negative attitudes; and third, the acceptance of positive ones. The therapy program leads clients step by step from self-centeredness to self-transcendence. Identification with their symptoms locks them into selfcenteredness. Excessive attention to negative factors blocks their view beyond themselves. Only when they have broken through the shells of their self-centeredness and the barriers ofthe negative factors are they able to see the positive factors in new meaningful activities and experience beyond themselves, and thus the way is open to a healing process. 
The Viennese philosopher Leo Gabriel said: "The animal is the world, the human being has the world." To "have" the world means to be able to find one's own attitude toward the world. To be able to change one's attitude is a specifically human quality, not available in the physio-psychological dimension: it is a quality of the human spirit. 
REFERENCES: 
1. Lukas, Elisabeth. "The Four Steps of Logotherapy," in Logotherapy in Action, Joseph Fabry, Reuven Bulka, and William Sahakian, eds. New York, Jason Aronson, 
1979. 
The Meaning of Children's Play 
The meaning of children's play may be an activity that allows them to be creative or skillful, or an experience they can share with others or in some way relate to their lives. 
Toy manufacturers tend to produce games that provide little opportunity for children to find meaning: dogs that bark at the push of a button, battleships that sink an enemy, race tracks for fancy toy cars that chase each other in circles, space creatures that can be taken apart and put together again. These toys provide fun but are soon forgotten. How much more lasting is the interest ofa child in a simple boat carved from a branch and floated in a pond. The child knew what the carving was for, it had a goal in view, and found satisfaction in having accomplished a selfchosen task. 
Children at play are often as alienated from meaning as their parents are alienated from meaning in their work. They feel bored and rebel and become destructive -on the toys, on things in the home, school, neighborhood, and on other people. A German magazine featured an article, "What to do when children hit parents." A professor of psychology advised the threatened parent: "Quickly hand the child a vase and let him smash it against the wall. That will abreact his aggression." 
Such advice is based on the concept of the human being as a reservoir of pent-up emotions which have to be released at any price when the dam is threatening to burst. This concept of the human being completely disregards the dimension of the spirit and reduces the person to a helpless bundle of repressed drives. 
In our counseling center we tried an experiment with six extremely aggressive children who caused their parents great worries. These children slit open the belly of a new teddy bear, tore off the leg ofa doll, scribbled and crumpled up the pages of an illustrated book, let air out of balls, smashed toy cars -children who simply did not know how to play but only how to destroy and throw away the ruined toy. 
We asked the parents to collect the pieces of the broken toys and bring them along to the first session. To the children we suggested a plan: they were to make their own toys from the heap ofthe discarded pieces. They were to put together something new. complete, and beautiful, and this was to be done in cooperation of them all. 
The children were asked to contribute ideas 
because the toys were not simply to be 
repaired but to be rearranged in a new 
35 
manner. They decided, for instance, to reassemble the broken dolls and their torn-up clothes so they would represent various races and nations, with an object in their hands typical of their group. The children painted, sewed, scraped, hammered, stuffed bellies, redrew faces, pasted hats, and covered animal figures with pieces of fur and wool. They drew lots to win each completed new toy which then was presented to the lucky winner. 
The hypothesis behind the experiment was based on the logotherapeutic view of human nature. The goal was to establish a meaningful connection between their toys and their lives, to arouse their interests, to let them see a value in the things around them that meant something to them, and to challenge them with a task that allowed them to use their energy constructively. The children were led away from a mere consumption of gifts and toward a goal-oriented activity which allowed them to contribute their ideas and their efforts through a creative process, to a task to be achieved. 
It occurred to none of the children to frivolously destroy the things they had so painfully assembled. The parents could not believe their eyes when they saw how carefully their children handled their new toys. Half a year later we had to discontinue the experiment with this particular group of children because they had learned to handle their toys adequately, and not enough broken toys were available. 
I do not think we would have achieved the same result if we had handed the children vases to be smashed against a wall. I am convinced their aggressiveness would have become stronger and the living room of their parents would eventually have resembled a battlefield, under the supposition that smashing was the proper way to abreact aggressiveness. 
Perhaps our little experiment contains a hint for parents and educators: If we want to help our young we must help them find tasks they consider meaningful, and let them do these tasks. But beyond that, we also must be prepared to set an example and live our lives in a meaningful way, dominated not by the gratification of needs and the abreaction of drives but by conscience, will, and reason. 

Frankl's Books are "Bibliotherapy" 
In her article "The Place of Logotherapy in the World Today" (International Forum for Logotherapy 113) Edith Weisskopf-Joelson coined an ingenious word to describe the role of the logotherapeutic literature. The books, she says, are "bibliotherapy." Unfortunately, the word was garbled by a misprint. The passage from her article is worth repeating. It should read: "Logotherapy is a message for the sick and the healthy; it is 'preaching' in the best sense of the word. Therefore, most of Frankl's books are 'bibliotherapy.'... The patient and the 'healthy' reader can extract the message directly from Frankl's and other books on logotherapy." 
36 
Philosophical Therapy: A Variation on Logotherapy 
William S. Sahakian 
Like logotherapy, "philosophical psychotherapy"4 is a cognitive form of therapy producing behavioral change and emotional control by restructuring the patient's thoughts, philosophical outlook, or attitude. Our beliefs, intellectual viewpoint, and perspective on life affect our personalitites as much as our physical environment or the external stimuli to which we respond. Much of the time our philosophical attitude toward the world determines how we will respond in a particular situation or to a given stimulus. 
The philosophical psychotherapist seeks to alter personality by effecting changes in the patient's philosophy of life. The patient learns to face circumstances more "philosophically." A certain type of philosophy can incline one toward pessimism, moroseness, and depression, while another philosophical outlook on life predisposes a person toward optimism, exuberance, and contentment. The attraction of philosophical psychotherapy is its success where other psychotherapeutic systems have failed. 
Use in "Shop-Worn" Cases 
Philosophical psychotherapy 7 was spawned when two patients failed to respond to the capable psychotherapeutic care received from qualified psychiatrists. Because ordinary methods of therapy proved futile, it seemed advisable to attempt new techniques on these two patients. It was found that philosophical psychotherapy works best in "shop-worn" cases, that is, with persons who have gone shopping from psychotherapist to psychotherapist, dissatisfied by lack of progress. 
Mr. X's continuous attempts at eliminating an incorrigible neurotic sympton proved futile. Despite his turning to many psy

chiatrists for help, he failed to uproot the symptom, which he interpreted as a signal of deteriorating mental health. He suffered from a number of symptoms, and in addition was plagued by a recurring sense of anxiety that was eroding his peace of mind, and -as he thought -his mental stability. Unless he could free himself from his anxiety, he was convinced that his state of health would slide down to "insanity." The greater the effort exerted in expelling anxiety from his personality, the worse he suffered in consequence of it. It was the type of case that led Frankl I to paradoxical intention, and it was obvious that this man's condition was compounded by what FrankJ2 termed "anticipatory anxiety." 
Mr. X's attempts to escape the clutches of anxiety proved disastrous. Rather than finding any relief, he complicated his situation by adding emotional exhaustion and despair by his numerous vain attempts to gain mastery over his neurotic symptoms. His succession of failures left him demoralized, depressed, and emotionally depleted. He maneuvered himself into a state in which the most pressing issue was not his neurosis but distress suffered from enormous expenditures of emotional tension in fruitless attempts to dominate neurotic anxiety. Anxiety bedeviled him because he felt that if left unabated it would destroy his mental health. Paraoxically, however, the reverse of all he attempted resulted: his efforts intensified his sense of vulnerability to anxiety, produced emotional fatigue, and bred discouragement and depression. Repeated failure in containing his anxiety merely contributed to the deterioration of his condition. His condition had undergone a fundamental alteration. 
37 
Now, however, the root of his trouble was no longer the manifest neurosis with which he had become so well acquainted over the years (and with which he could come to terms) but the profounder concern that symptoms left unabated would destroy his mental health. 
At this juncture, philosophical psychoherapy was introduced. At a loss as to know what Mr. X expected of me (when a half dozen psychiatrists and psychologists had failed) I was warned not to contribute to failure by repeating a system of psychoherapy that had been tried and found wanting. To do so would only reinforce his growing suspicion of the ineffectualness of psychotherapy and the hopelessness of his condition. If competent psychiatrists were unsuccessful in removing Mr. X's anxiety, why should I be more effective using their technique? My only hope for success lay in employing a different method. 
Knowing from experience that some lectures of mine had a palliative effect on the audience's feelings of anxiety, stress, low morale, and depression, I decided to apply the stoical philosophy contained in these lectures to Mr. X's situation. He was advised to stop fighting his neurosis, to accept it with an attitude of indifference, --to be philosophical about it. If other people with handicaps accept theirs and yet continue with the business of life, why could he not do the same? Rather than fighting his neurotic symptoms, why not accept them as a part of his personality9 
Had it not been for the fact that his 
symptoms proved unresponsive to the efforts 
of six psychiatrists, I would not have dis
missed them as "incurable." Thus, my 
criterion of incorrigibility ofsymptoms in this 
case was the failure of six competent psy
chiatrists to make any headway. Later I 
discovered that philosophical psychotherapy 
works best with these cases where a number of 
psychotherapists have failed. 
Mr. X's attitude of philosophical indif
ference proved a turning point in his state of 
well-being. The unceasing expenditure of 
energy were no longer squandered on battling 
his neurotic symptoms; rather his energies 
were now constructively used in productive 
living. Because he was no longer emotionally 
depleted (but emotionally vibrant), he con
sidered himself a well man. And this was the remarkable upshot of his entire therapeutic experience--the insistence that he was cured of his neurosis, when the only thing that actually occurred was a recharging or rebuilding ofemotional reserves, that is, a more constructive use of emotional energies. 
Philosophy was first appreciated as a therapeutic agent when students regularly commented on the "good feelings" experienced following certain lectures. Unlike the usual transfer of information, these lectures had a salutary psychological effect. Some students reported being able to cope with their problems and to confront life's crises better. A review of those lectures proving therapeutic showed that they were stoical in nature. The philosophy ofthese lectures was extrapolated for psychotherapeutic application. Thus in philosophical psychotherapy, a person is encouraged to face life's problems philoophically-to meet them head-on with an air of philosophical indifference. If a situation cannot be changed, then one must change his attitude toward it. Under such conditions, attitudinal changes alter the entire situation. Otherwise, the psychological result will be that of an irresistible emotional force confronting an immovable object. The emotional forces of the individual will suffer. If you cannot attain what you like, then like what is attainable. The philosophical belief is that 
neither heaven nor earth contain anything over which it is worth being miserable, since a tranquil state of mind is of infinite intrinsic worth. What shall a person give in exchange for a soul in peace with itself? 
Living With the Problem 
Before proceeding with actual psychotherapy, it is advisable to examine the patient's philosophical Weltanschauung, to see whether it enhances or deteriorates their mental wellbeing. Often a person's philosophy colors his outlook on life, affects his personality, and has a bearing on his emotional well-being and general mental health. For example, selfadministered brain-washing like self-hypnosis can be anxiety-provoking or anxiety-alleviating. A person should not consume any kind of doctrine any more than indiscriminately ingesting anything that fits into the mouth. 
Once a patient's philosophical beliefs are ascertained and determined to be counter
38 
productive to wholesome living or to eliciting constructive responses, the psychotherapist acting as facilitator, should see that deleterious beliefs are exchanged for those conducive to vibrant mental health. The psychotherapist, then, is a psychological broker, exchanging healthy beliefs and healthy attitudes for unhealthy ones, an invigorating philosophy for a depressing one. In other words, the psychotherapists's task is that of changing patients' attitudes, to aid them in becoming more philosophical about their condition, and, if necessary, to assist them in acquiring an attitude of philosophical indifference toward their irremediable problems. 
With these thoughts in mind, let us pursue the dialogue of Mr. X: 
You have told me of some of your neurotic symptoms and you say that you want me to help you eradicate them. Why? I asked. 
What do you mean, Why? he replied. Any normal person would want to get rid of them. They are tormenting problems and disturb me terribly. They have made me miserable for a long time. 
Have you ever tried to live with them? I asked. Some crippled people have learned to live with their ailments. They do not spend every hour oftheir waking day or an entire lifetime striving to gain mastery over their problems. They accept their plight and learn to live with it, as do many other people who are handicapped victims. Some persons with the loss of an arm or with a heart condition learn to live within the limitations of their handicap; they do not waste their time and exhaust themselves vainly combatting their problem. Is it not possible for you also to do something comparable? 
After staring at me with a vacant look for almost a minute, the patient's eyes and face lit up, and he smiled broadly and said: "Why didn't the others (psychotherapists) tell me this long ago? Of course, I can accept it and live with it. In fact, I feel better already. It is most ironic," he added, "that I should come to a therapist, requesting that he cure me, and then have him tell me to keep my problem" (p. 296).6 
A second case was a woman in her early fifties suffering from anxiety with its physiological counterpart of pain located in the brain in the region of her right ear. Beca'use she had undergone "successful" surgery for a brain disorder, the clinic responsible for her surgery referred her to their chief psychiatrist. His efforts proved futile. By the time I saw her she was fast approaching the conviction that unless the pain subsided, she would lose her sanity. 
Because she made no headway with psychiatry, we turned to philosophical psychotherapy. Our dialogue ran as follows: 
Is the pain severe? Yes, at times. Is it endurable? Not at times, and I think that it is 
getting worse. Is it very painful at this moment? Excruciating! Do you feel that the pain will become 
so intense that it will drive you out of your mind? 
How did you know that? That is precisely what terrifies me; I am afraid that I am going insane, that is, the pain will get worse until I lose my mind. 
Why do you want to get rid ofthe pain? 
Nobody wants pain (she said looking at me as if I were rather peculiar for asking such an asinine question). 
If you could feel confident that no matter how severe the pain in your head becomes it will, nevertheless, not drive you to "insanity" as you put it, do you think it would then be possible for you to endure the headache? 
Why? Won't it make me insane? If it doesn't, do you think that you 
could live with it? Yes, I'm sure that I can. What if I were to tell you that your 
headache will never cause "insanity"; and if you were ever to become "insane," it would not be from your head pain. 
Is that true? Actually, a person becomes adapted to 
pain. Truly? It is true. (Then smilingly she said): I don't think 
that you will believe it but the pain in my head has subsided considerably, and I 
39 
know that I can endure it (p. 34).3 
Once the tension was gone, the pain was endurable. Emotional stress was the greater suffering. Unabated emotional stress leads to despair and depression. It is suffering pain without hope-without anything to look forward to but despair. 
Range of Application 
Philosophical psychotherapy proves es
pecially effective in intractable cases that 
resist the major psychotherapeutic systems.5 
As stated before, 1t should be the treatment 
method of those long-term recalcitrant cases 
that fail to yield to psychotherapy. 
But in addition to neurotics of long standing, philosophical psychotherapy is also a blessing to so-called "normal" persons seeking to maintain their slim hold on "sanity." People with diverse emotional problems, particularly those plagued with anxieties and other stressful events, or the average person facing the crises of life that each of us must sooner or later encounter, benefit from philosophical psychotherapy. It is also useful to those individuals in whom profound personality changes are sought, where a thorough alteration of lifestyle or a new outlook on life will prove salutary. Philosophical psychotherapy strengthens the patients' awareness that in the dimension of the spirit they can take a stand against physical and psychological blocks and limitations. Experience has shown that this method works best with people who are open to intellectual or rational arguments as motivation to change. 
WILLIAMS. SAHAKIAN is professor of Philosophy and Psychology, Suffolk University, Boston. 
REFERENCES: 
I. Viktor E. Frankl. "Paradoxical Intention and Dercflcction." Psychotherapy: Theory, Research and Practice, 1975, 12, 3. 226-237. 
2. --------The Unheard Cry for Meaninfr New York, Simon and Schuster, I 978. 
3. Sahakian. William S. ··stoic Philosophical Psychotherapy," Journal of1ndividual Aychology, 1969, 25, I, 32-35. 

4. 
--------"Philosophical Psychotherapy," Psychologia-An International Journal of Psychology in the Orient, 1974, I7, 4, 179-185. 

5. 
--------"Psychotherapy: An Existential Approach," Journal ofIndividual Psychology, 1976 32, I. 62-68. 

6. 
--------Psychotherapy and Coun


seling: Techniques in Intervention. 2nd ed. Chicago, Rand McNally. 1976 
7. --------"Philosophical Psychotherapy." In Richie Herink(Ed.), The PsvchotherapyHandbook, pp. 473-476. New York, Meridian: New American 
Library. 1980. 
40 
A New Remedy of Narcissism 
David Williams and Steven Patrick 
The ancient mythological figure Narcissus 
has provided modern psychiatry with a 
valuable concept. When the myth was 
originally conceived, it is unlikely that anyone 
suspected that a whole culture would even
tually suffer from Narcissus' affliction. It 
would appear, though, that this is indeed the 
case today in America. When Tom Wolfe 
suggested the label of the "Me Decade" in 
1976, overnight the label became synonymous 
with an era. IO 
Manifestations of the "Me Decade" are in 
evidence in our psychopathologies. Nu
merous psychiatrists and psychoanalysts have 
made this observation. Beldoch has spoken 
of narcissism as, "the archetypal pathology of 
our age."2 Bach has commented that, "You 
used to sec people coming in with handwashing 
compulsions, phobias, and familiar neuroses. 
Now you see mostly narcissists. "I Hendin 
notes that, "It is no accident that at the 
present time the dominant events in psycho
analysis are the rediscovery of narcissism ... "6 
If, as various clinical experts believe, nar
cissism is a dominant emotional disorder of 
our time, one would expect to find an 
abundance of therapies available to treat it 
effectively. A review ofthe literature suggests 
that this is not so. Lasch claims that the 
"massive self-examination advocated by the 
majority of today's psychic healers has pro
duced few indications of self-understanding, 
personal or collective."7 
Not only can a case be made that most 
human potential therapies fail to relieve 
narcissistic disturbances, they actually exacer
bate them! Lasch comments about this irony: 
"As social life becomes more 

and more warlike and barbaric, personal relations, which ostensibly provide relief from these conditions, take on the character of combat. Some of the new therapies dignify this combat as 'assertiveness' and 'fighting fair in love and marriage.' Others celebrate impermanent attachments under such formulas as 'open marriages' and 'open-ended commitments.' Thus they intensify the disease they intend to cure. "7 
Lasch sees the human potential therapies as 
patently self-defeating. He writes: "Love as self-sacrifice or self-abasement, 'meaning' as sublimation to a higher loyalty-these sublimations strike the therapeutic sensibility as intolerably oppressive, offensive to common sense and injurious to personal health and well-being. To liberate humanity from such outmoded ideas of love and duty has become the mission ofthe post-Freudian therapies and particularly of their converts and popularizers for whom mental health means the overthrow of inhibitions and the immediate gratification of every impulse."7 
41 
Numerous other writers have commented on the degree to which the human potential therapies overindulge narcissistic tendencies at the expense of altruistic values. Marin has noted that, "selfishness and moral blindness now assert themselves in the larger culture as enlightenment and psychic health. "8 Beldoch claims that the picture which had been held up as the epitome of psychic health in the mid sixties was actually a picture of "severe psychopathology." In Beldoch's view the "ideal'' was really the victim of his own narcissism.2 
One type of post-Freudian therapy which cannot be accused of pandering to narcissistic indulgence is logotherapy. Unlike many therapies logotherapy openly advocates certain values including responsibility, self-sacrifice, love and commitment. Logotherapy does not advocate, "the overthrow of inhibitions and immediate gratification of every impulsc."7 Clearly, logotherapy is not one of the post-Freudian therapies of narcissistic indulgence. 
Some writers claim that even the concept of 
self-actualization ironically has had undesir
able effects. Cinnamon and Farson write: 
"Once upon a time a psychologist suggested that a healthy person should be striving for self-actualization. A movement built up around this idea. Now, actualization is one of the great road blocks to the acceptance of self. The band-aid has become the problem."3 
Frankl had foreseen the problem that selfactualization would create long before Cinnamon and Farson. In 1967 Frankl wrote, " ... self-actualization like power and pleasure belongs to a class of phenomena which can only be obtained as a side effect and are thwarted precisely to the degree which they are made a matter of direct intention. "4 More recently he made this point in even stronger terms: " ... it is ruinous and selfdefeating to make it (self-actualization) the target of intention. "5 
According to Frankl, self-actualization is distinctly subordinate to self-transcendence. It is a side effect of self-transcendence, which is a central concept in logotherapy. Frankl sees it as a sine qua non for human existence: "Self transcendence, I would say, is the essence of existence; and existence in turn means the specifically human mode of being."5 
Sugerman sees the major world religions as pointing to freeing oneself by achieving relatedness to others--not to self. She further notes that religious wisdom universally suggests one's salvation lies in self-transcendence and not in egocentrism.9 
Self-transcendence always involves a reaching beyond one's self to something which is outside the self. " ... Man's primary concern," Frankl writes, "does not lie in the actualization of his self, but in the realization of values and the fulfillment of meaning potentialities that are to be found in the world rather than within himself..."4 "Oftentimes this realization of values" and "fulfillment of meaning potentialities" results in the losing of one's self. "He (man) finds himselfonly to the extent to which he loses himself in the first place, be it for the sake of something or somebody, for a sake or a cause or a fellowman..."4 
The notion that the losing of one's self may be a joyous occasion has ancient roots. Freud discovered that the self was something other than a handsome god or goddess waiting for the marvelous moment of discovery. Freud, along with many poets and philosophers before him, recognized that there was an unconscious aspect ofthe self that entertained shocking and embarrassing ideations. 
Frankl foresaw that today's psychotherapies with their excessive emphasis on selfand self-reflection would create problems. His foresight ofthis is evident in that he coined the term self-transcendence in 1949. Someone incapable of self-transcendence is the likely victim of hyperreflecting--inordinate reflecting upon the self. Frankl maintains that hyperreflecting, itself, can cause neuroses as well as exacerbate any neurotic conditions already present. Many therapies foster hyperreflection, either intentionally or otherwise. For example, in treating feelings of inferiority, many therapies would call considerable attention to these feelings and as a consequence a great deal of energy is focused on them. Frankl would treat someone with this problem in such a way as to withdraw attention from the problcm.5 
42 
In logotherapy a term closely related to hyperreflection is hyperintention. Hyperintention is seen to be an equal liability to one's mental health when the object of intention is pleasure or happiness. Frankl maintains that even the "pursuit of happiness" is a futile enterprise when happiness, itself, is made the immediate object of pursuit. He states, "In the final analysis it (the pursuit of happiness) is self-defeating, for happiness can arise only as a result of living out one's self-transcendence, one's dedication to a cause to be served or a person to be loved. "5 Frankl also argues that hyperintending pleasure in the area of sexuality is equally self-defeating and creates such problems as impotence and frigidity. To counteract problems with "fighting for pleasure," Frankl has developed a technique called dereflection. In treating persons with impotence and frigidity problems, interventions are made which allow them to forget themselves and concentrate, instead, on their partners' pleasure. Frankl reports many cases in which long-standing problems have been treated effectively using this technique. The forgetting of one's self that occurs in dereflection often has remarkable benefits. To a large degree the technique of dereflection is the very antithesis of most modern-day therapies which would over-emphasize selfreflection. Dereflection can be seen as an implicitly antinarcissistic technique, for it works only to the degree that one is able to forget one's self.5 
Paradoxical intention is another logotherapeutic technique which can be viewed as implicitly antinarcissistic. Frankl regards it as absolutely essential to evoke the clients' sense of humor when attempting to implement paradoxical intention. The clients are encouraged to laugh at their symptoms, to see them as totally ludicrous. Clients with inordinate fear of extensive perspiring are advised to really outdo themselves to try for bucketfulls of perspiration, to try for a new Guinness world record in perspiring. The use of such humor is clearly contrary to narcissistic indulgence. It would be difficult to imagine an activity more antithetical to the narcissistic theme than laughing at one's self. Ridicule of the beloved self is diametrically opposite to excessive admiration of the self. Whatever one may imagine Narcissus doing before his reflecting pool, the last thing one would imagine is Narcissus breaking up with laughter and ridiculing his image. If he had been able to do this, perhaps he would have 
been able to escape his terrible fate. 
This essay has attempted to show that most of the human potential therapies actually exacerbate narcissistic problems by focusing indulgently upon the self. Logotherapy, on the other hand, counteracts narcissism by focusing outwardly toward "people to love and causes to serve." 
DAVID A. WILLIA MS is on the teaching staff of the Department of Counseling, University of Georgia, Athens, Georgia. STEVEN PATRICK is director of the Day Treatment Program ofthe Community Mental Healrh Center in Athens. They are colounders and directors of the Logotherapy Counseling Center in Athens, Georgia. 
REFERENCES: 
I. Bach, S. Time, September 20, 1976, p. 63. 
2. Beldoch, M. "The Therapeutic as Narcissist," Salmagundi 20, 1972. pp. I 35-152. 
3. Cinnamon, K. and Farson, D. Cults and Cons -The Exploitation of the Emotional Growth Consumer. 
Chicago, Nelson-Hall, Inc. 1979. 
4. 
Frankl, V.E. Psychotherapy and Existentialism. New York, Simon and Schuster. 1967. 

5. 
____ , The Unheard Cry for Meaning. New York, Simon and Schuster, 1978. 

6. 
Hendin, H. The Age ofSensation. New York, W.W. Norton and Company, 1975. 

7. 
Lasch, C. The Culture of Narcissism. New York, Warner Hooks, Inc., 1979. 


8. Marin, P. "The New Narcissism," Harper's, October, 1975, pp. 45-56. 
9. Sugerman, S. Sin and Madness· Studies in Narcissism. Philadelphia, Westminster Press, 1976. 
IO. Wolfe, T. "The 'Me' Decade and the Third Great Awakening," New York, August 23, 1976, p. 26-40. 
43 
Life Purpose and Subjective Wellbeing in Schizophrenic Patients 
Ruth Hablas, R.R. Hutzell, 
and Ed Bolin 
Viktor Frankl shares with Nietzsche the 
conviction that if one has a reason for living, 
the circumstances oflife may be far from ideal 
yet not cause serious personal problems. A 
main point of logotherapy is that "a person 
who has a real reason to live can put up with 
almost any living conditions. "I It seems 
reasonable, then, to hypothesize that under 
most normal circumstances a person who has 
found meaning and purpose in life will also 
manifest life satisfaction or subjective well
being. Thus, scores from psychometric 
instruments designed to measure life purpose 
ought to correlate with scores from measures 
of subjective well-being. 
The hypothesized correlation of life pur
pose with subjective well-being reflects a 
nonpsychotic population. The life meaning 
of a psychotic individual often differs dras
tically from that ofnonpsychotic persons, and 
it may be asked whether that difference affects 
the hypothesized relationship between life 
purpose and subjective well-being. More 
precisely, will psychotic individuals who 
manifest life purpose, though it may be 
bizarre or unusual. also manifest subjective 
well-being? Or, possibly, might a lack of 
subjective well-being be necessary to maintain 
the psychosis which supports the unusual life 
purpose? 
To answer these questions, an instrument 
designed to measure life purpose and an 
instrument designed to measure subjective 
well-being were administered to twenty-five 
schizophrenic inpatients at the Knoxville, 
Iowa, Veterans Administration Medical 
Center. The mean age ofthe patients was 60.6 
years, ranging from 36 to 80, and the 
diagnoses were as follows: paranoid = 13, chronic undifferentiated = 6, catatonic = 3, hebephrenic= 2, simple= I. Life purpose was measured by the Life Purpose Questionnaire, designed specifically for use with geriatric, neuropsychiatric patients and having a significant correlation (r =+. 79,p ( .01) with the Purpose-In-Life (PIL) Test.2 Subjective wellbeing was measured by the Life Satisfaction Index.3 The resultant correlation between the scores of the two tests was + .62 (p ( .0 I), suggesting that schizophrenic individuals who find greater life purpose also experience greater subjective well-being. Though correlations do not prove cause-and-effect relationships, the obtained correlation is what could be expected if life purpose and subjective wellbeing are causally interrelated. 

The results of our experiment possibly have several practical implications for applied psychotherapy and logotherapy with psychotic individuals. In cases where direct psychotherapy has been unsuccessful with patients whose psychosis is manifested primarily as an unusual life purpose (e.g., delusions of grandeur), the hypothesized relationship between life purpose and subjective wellbeing suggests that the patient might be caused to move from maintaining the unusual life purpose if the patient's feeling ofsubjective well-being can be decreased. A most direct example of this process can be seen through reinterpretation of behavior modification techniques designed to decrease delusions of grandeur. Within the behavior modification paradigm, the patient effectively experiences decreased rewards for maintaining the delusion, the lack ofrewards reduces satisfaction with life in many such patients, and this is followed by a decrease in the unusual life 
44 
purpose. It might be an interesting experiment to compare life purpose measures administered before and after such behavior modification procedures. Another practical implication of our experiment concerns cases where the patient is experiencing little subjective well-being. Here it is possible that the patient can be made more comfortable through experiencing greater subjective wellbeing as a result of applying logotherapy and determining life purpose. This can be accomplished directly by application of the rather structured logoanalysis technique advocated by Crumbaugh. I Our own experience has been that even severely regressed functionally psychotic individuals can benefit from logoanalysis when considerable structure is afforded in the therapy process. Some organically psychotic individuals can similarly benefit, though we have not yet been convincingly successful when attempting to treat those psychotic organics who are disoriented to person, place, and time. 
RUTH HABLAS, Ph.D.; R.R. HUTZELL, Ph.D. and ED BOLIN, Psy.D. area practicum student, a clinical psychologist, and a psychology intern, respectively, at the Knoxville, Iowa, Veterans Administration Medical 
Center. 
REFERENCES: 
I. Crumbaugh. James C. Everything to Gain. Chicago. Nelson-Hall, 1973 
2. Crumbaugh, James C. and Leonard T. Maholick, 
Manual ofInstrucrionsfor the Purpose ofLife Test. 
Munster, Indiana. Psychometric Affiliates, 1969. 
3. Larson, Reed. "Thirty Years of Research on the Subjective Well-being of Older Americans." Journal of Gerontology, I 978, 33, I 09-125. 
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45 
THE INTERNATIONAL FORUM FOR LOGOTHERAPY 
Journal of Search for Meaning