SOURCE_DOCUMENTS/journal_003_2.txt

Volume 3, Number 2 Fall 1980 
CONTENTS 
Psychotherapy on its Way to Rehumanization Viktor E. Frankl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The Logotherapy View of Human Nature Elisabeth Lukas .............................................................. 10 The Best Possible Advice Elisabeth Lukas .............................................................. 13 Modification of Attitudes Elisabeth Lukas ..............................................................25 The Meaning of Children's Play Elisabeth Lukas.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .........35 Philosophical Therapy: A Variation on Logotherapy William S. Sahakian ..........................................................37 A New Remedy of Narcissism David Williams and Steven Patrick ............................................ .41 Life Purpose and Subjective Wellbeing in Schizophrenic Patients Ruth Hablas, R.R. Hutzell, and Ed Bolin ........................................44 Book Reviews ...................................................................46 Bibliography ....................................................................50 
The International Forum for Logothcrapy Vol. 4. No. I. Sprin~ Summer 1981 
The Frontiers of Logotherapy 
Joseph Fabry 

It is often assumed that logothcrapy originated in the concentration camps during World War II. This is a false assumption. Dr. Frankl developed his basic ideas as a student during the Twenties and Thirties, and later as an intern and staff member at Vienna's leading mental institution, Steinho_f Intuitively he developed the basic concepts of what he first called existential analysis, and later logotherapy-concepts and methods that now, fifty years later, are being empirically tested and confirmed. 
The basic tenets of logotherapy are: meaning exists under all circumstances and our will to meaning is our basic motivation for living and acting. We have the freedom to find meaning, at least through our attitudes toward situations which seem meaningless, and a lack of meaning can result in an "existential vacuum." We have a uniquely human dimension. the "noetic," or the human spirit. where we are not driven, as in the psychological dimension but where we arc the drivers, the decision-makers. Logotherapy maintains thal some neuroses originate not in the psyche, but in the noos and therefore require a treatment making use of our uniquely human resources of which the will to meaning is one. Such "noogenic neuroses" can cause psychological and physical symptoms, and total health requires consideration of the total person, including body, psyche and noos. Among new methods that need to be applied arc paradoxical intention and dcreflection. All these ideas were contained in the manuscript of a book that was completed in 1942, but was lost when Frankl entered his first concentration camp. 
The death camps did have a decisive impact on logothcrapy-not so much on its basic concepts but on its frontiers. It is one of the paradoxes--and logotherapy contains many-that the expanding frontiers of logotherapy 
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International Forum for Logotherapy 
were discovered within the most limiting circumstances possible, and that a therapy of meaning flourished in the most meaningless situation imaginable. 
PROPHET AND WITNESS 
Before the death camps Frankl was a prophet warning of the dangers of a meaningless life. The camps made him a witness of the meaningless life, a survivor who was reduced to 80 pounds and came out stronger than he went in. A prophet is seldom believed but the testimony of a witness is convincing. Many people who go through their personal concentration camps-the unescapablc traps of incurable sickness, depression, or loss of a dear person -find comfort and healing in logotherapy. 
The barbed-wire fences of the concentration camps opened the frontiers of logothcrapy from a medical system to a system of human concern. Frankl started out as a medical student. His influential teacher, Alfred Adler, introd uccd individual psychology as a treatment of the sick. Adler's teacher, Sigmund Freud, developed psychoanalysis as a medical method. Logotherapy, which was the child of individual psychology and the grandchild of psychoanalysis, was also conceived as a method of curing the sick. In 1964 a group of American theologians asked Frankl some searching questions about logotherapy's place. "Logotherapy," he told them, "is a school of psychiatry and thus belongs to the medical practice rather than being a theological theory." But at that time he already was aware of the expanding frontiers of logotherapy beyond the field of medicine. "Curing diseases, psychoses, neuroses through logotherapy," he said, "as a rule will require an 
M.D. degree. Also as medical ministry, logotherapy in general is still the job of an M.D., but curing people of existential frustration, despair, or emptiness is more the assignment for the pastor, priest, rabbi, counselor, or p~ychologist." When one of the visitors quoted statistics showing an increasing movement from the religious counselors to psychiatrists, Frankl responded: 'This widening of the psychiatrist's clientele might have been, unconsciously for me, underlying my struggle for four decades for a wider concept of psychotherapy, including the noological dimension, the spirit. thereby building up logotherapy. This migration from the pastor to the doctor means that psychiatry has now been allotted an additional assignment." 
This additional assignment goes beyond curing the sick to comforting the suffering. This, as Frankl admits, is not an invention of logotherapy but a traditional task of medicine. It is contained in a motto engraved in Vienna's 200-year-old hospital near his apartment. Hut comforting the suffering was neglected in the onrush of medicine into the Twentieth Century. Frankl, early in his career, became concerned about what he called "the dehumaniza
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Joseph Fabry 
tion of psychotherapy." What he felt was needed was an understanding of human beings in their totality, and so he set out on a career in psychiatry in which he introduced the concepts of meanings and values. "At that point," he recalled, "I suspended what I had learned from my great teachers and began listening to what my patients were telling me-trying to learn from them." 
He listened to the patients in the mental hospitals, but also to others he helped but were not "sick": the unemployed during the Depression, the young in the crisis centers he founded, and his fellow inmates in the concentration camps. He realized that people, in order to live, need something to live for. 
I am convinced that the book which Frankl reconstructed after his release from the camps was a stronger and more humane document than the manuscript he lost when he went in. Its English title, "The Doctor and the SouL" was given to it by the publisher and doesn't meet Frankl's approval. The word "soul" is not in Frankl's professional vocabulary, you will not find it in his writings. Frankl's original title translates as "Medical Ministry." It expresses his belief that the doctor must minister to the patients' needs, hopes, and longings for a meaningful life. And he must do so regardless of their religious or nonreligious convictions. 
The frontiers of logotherapy, after the death camps, have expanded in at least four areas: the clientele, the therapists, the fields of application, and the geographical territory. 
EXPANSION OF CLIENTELE 
The clientele of logotherapy has expanded from the sick to the hopeless, the frustrated, the trapped, the despairing. What Frankl learned from the camp inmates was that no walls, no barbed wire, no armed SS men could take away their last and most important freedom: to take a stand in hopeless situations. Those who asked themselves why it had happened to them and what they had done to deserve this fate, only banged their heads against a wall. But those who asked themselves, instead, how they could live within the walls, what they still could do within their restricted circumstances, were able to find glimpses of meanings. Frankl also learned that those who still believed in a meaning in life, even in their apparently meaningless situation, had a better chance of survival than those who saw no goals for which it was still worth living. He found confirmation of his concept that meaning can be found not only through what we do and what we experience, but also through the way we bear unavoidable suffering. Facing an inescapable fate opens up access to the highest meaning a human being can achieve. If we find meaning in what we do, we may change the world around us, at least a 
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International Forum flJr l,ogotherapi· 
tiny little bit. But if we find meaning by hearing heroically a suffering from which there is no escape, we change ourselves and come a little closer to our full potential, to what we arc meant to he. 
These lessons were at least as important for the young doctor as what he had learned from his great medical teachers in Vienna, including Freud and Adler. The camp experiences showed Frankl that human health is a matter of philosophy as much as medicine. So, after his release from the camps, Frankl the medical man went back to the university to receive another degree -in philosophy. Sometimes, in a whimsical mood, Frankl says that he is a graduate from three schools: the school of medicine, the school of philosophy, and the school of life via the concentration camps. 
Those camp experiences gave logotherapy an added dimension that was necessary for its survival. Frankl found little support from his scientifically minded medical colleagues for a therapy that included such a nonscientific area as the human spirit. But because it stressed those aspects of the human personality which religious counselors are labeling the human spirit, logotherapy was readily accepted hy religious counselors who during the postwar years were not prepared for the onrush of people in despair who were not necessarily religious in the traditional seme. The search for meaning was open to everybody, to the religious and nonreligious. Logotherapy filled a timely need. More than that: it 4uenched a timely thirst, a longing for a meaningful life which is a prerc4uisite for human health. 
Out of this situation grew an ambiguity: does logotherapy belong to the 
medical field or to the field of philosophy and religion? Many articles have 
been written about logotherapy and religions, including Christianity, Juda
ism, Oriental faiths, humanism, and various kinds of philosophies. Hut 
equally much has hecn written about medical applications of logotherapy 
for phobias, obsessions, compulsions, sexual dysfunctions, endogenous 
depressions, and a variety of neuroses. 
Today's acceptance of holistic medicine has made this ambiguity at least 
partly obsolete. Health is seen as the result of a number of influences 
biological, psychological, and noological. The interrelationships of these 
three dimensions, which logotherapy has pioneered, today are widely 
acknowledged as essential to human health. Logothcrapy is therapy for the 
sick, ministry for the suffering, education for the confused, and philosophy 
for the frustrated. Most practicing logothcrapists would agree that its 
philosophy, its view of the human being and how we fit into the totality of 
life, is the basis for all applications of logotherapy. 
AREAS OF APPLICATION 
Frankl sees logotherapy applicable for five kinds of clients: For those suffering from noogenie neuroses, logotherapy 1s specific therapy. 
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Joseph Fahry 
For those suffering from phobias, obsessions, compulsions, sexual dysfunctions and other problems caused by "hyperreflection" and "hyperintention," logotherapy is applicable through paradoxical intention and dereflcction. 
For those facing unavoidable suffering, logotherapy becomes "logoministry." 
For those suffering from collective neuroses. logotherapy is "logoeducation." Included here are people living day-by-day who feel life is too short to bother abou\ finding meaning; the fatalists who feel it's hopeless to search for meaning because their fate is determined; the victims of collective thinking who accept their meanings through others-victims of either conformism or totalitarianism; and the fanatics whose search for meaning has been frozen. 
Finally, logotherapy is applicable as "logophilosophy" to the increasing number of people who feel empty, doubtful, hopeless, alienated, frustrated, trapped, in transition, or in despair. 
A sixth needs to he added to these five groups where logotherapy is a supplementary but a vitally important therapy. In this group are patients who have been helped with their physical or psychological problems hut still face the problem of meaning. What meaning does life hold for people whose limbs have been amputated, those cured from nervous breakdowns, or others detoxified from addiction? Here, logotherapy is used as "logosupplementation." 
Most of the clientele coming to professionals practicing logotherapy, arc not really sick but may believe they are sick because they feel unhappy, illadjusted. lonely, useless, and living a life not as meaningful as it might he. To label and treat them as sick will only bring them closer to actual sickness. I am always amazed how relieved clients arc when they are assured that their existential vacuum is neither a sickness nor a sign that they are on the verge of sickness, but simply proof that they are humans who are searching for meaning, have doubts that they can find it, and in despair when they cannot find it. It has become fashionable to label normal human reactions with fancy psychological terms. People who are afraid arc called "phobics." People who cannot make up their minds, label themselves "schizophrenic." A little poem pokes fun of this habit. Here is a woman speaking: 
I never get mad -I get hostile! I never feel sad -I'm depressed. If I sew or I knit, and enjoy it a bit. I'm not handy I'm simply obsessed. I never regret -I feel guilty; and if I should vacuum the hall, wash the woodwork and such 
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International Forum for Logotherapi· 
and not mind it too much 
am I tidy? No, compulsive, that's all! 
If I can't choose a hat, I have conflicts. 
I am senile if I forget. 
I never get worried or nervous or hurried 
anxiety, that's what I get. 
If I tell you you're right. I'm submissive, 
repressing aggressiveness. too. 
And when I disagree. I'm defensive, you sec. 
and projecting my symptoms on you. 
I'm not lonely -I'm simply dependent. 
My dog has no fleas. just a tic. 
So if I'm a cad, never mind, just be glad 
that I'm not just a stinker -I'm sick! 
It may be the task of the logotherapist to convince clients that they are neither sick nor stinkers but human beings with all sorts of potentials and barriers. and to help them come closer to their potentials, and either overcome the barriers where possible, or live within them where the barriers are immovable. 
This brings us to the second frontier of logotherapy, that of the therapist. The logotherapist no longer deals exclusively with patients, with sick people. He often deals with patients in the original sense of the word, homo patiens, the suffering person. Logotherapists deal with people in the various human predicaments of the Twentieth Century. They may be medical therapists, but they also may be logoministers, logoeducators, logophilosophers, logosupplementers, and some we may call logohelpers or logocarers because the essence of logotherapy is a participating caring. Even logotherapists dealing with strictly medical problems do not limit themselves to medication and psychotherapy, important as these may be, but also pay attention to the specifically human dimension and its resources. 
Logotherapists do not compete with other schools of therapy but offer additional approaches to be added to any method when the question of meaning arises. The meaning of life has to be faced not only in hospitals and the consulting rooms of doctors but everywhere. Therefore, the frontiers of logotherapy have expanded from psychiatrists and physicians to nurses, psychologists, family counselors, school and religious counselors, social workers, management consultants, teachers, and people working in detoxification clinics, nursing homes, and prisons. In all these places logotherapy is rarely used exclusively; it is an additional tool where a "therapy through meaning" seems appropriate. 
The variety of professionals seeking training at the Institute of Logotherapy is proof that the frontiers of logotherapy are expanding into the third 
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Joseph Fabry 
area-the fields of applications. As the editor of the International Forum for Logotherapv I have the opportunity to witness that expansion. It is not yet a massive expansion but it has enthusiastic pioneers in many directions. 
One of these directions is education. Arthur G. Wirth, professor of history and philosophy of education at Washington University, St. Louis, was one of the first to point out that the young, bewildered by chaos and violcm:c in today's world, need more than learning facts. He wrote: "They will learn in their education that it is possible to live with meaning by experiencing teachers who demonstrate authenticity in the quality of their lives and work. The life style of teachers and schools are contagious. If teachers are cynical, bored, and defeated the young will get the message, no matter how many literary classics they are required to read." 3 
The message is getting across to teachers and parents. They are beginning to realize that school problems such as truancy, vandalism, and drug addiction are rooted in the fact that children see no meaning in their learning, and indeed, in their lives. 
For years psychology has blamed parents for every conceivable trouble children get into. Parents arc beginning to see that it is impossible to bring up children without traumas, and that some children with the same traumas become, in some cases, neurotic and, in others, fulfilled. Logotherapists have shown that it is not the trauma that counts, hut how you take it-either as an excuse for failure, or as a challenge. What Professor Wirth said of teachers is also true of parents: If parents are cynical, hored, and hedonistic, their children will get the message no matter how many expensive toys are in their play rooms, and how many cars are in the family garage. 
The lesson is being learned in other areas. In the work situation: management is beginning to understand that if workers and employees are treated as machines and as expendable, the result will be absenteeism, shoddy workmanship, and alcoholism, no matter how many material benefits are heaped upon them. In the inner city, politicians have not yet learned that a feeling of uselessness will lead to crime, violence, and addiction, no matter how much money is spent on welfare programs. In the suhurhs, residents are becoming aware that their idolized affluence is the root cause of boredom, divorce, psychosomatic illness, and suicide. The prescription of self-discovered goals and meanings is valid for all age groups: The young have not yet found their direction; the middle-aged have lost their meaning in work when their career becomes stale, and their meaning in the family when the marriage becomes stale and the children move out; and the elderly begin to doubt that their lives ever had any meaning when they face retirement, illness, and death. 
The spreading of logotherapy is indicated in the hook Logotherapy in Action I where thirty logotherapists describe the application of logotherapy 
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International Forum for Logotherapy 
in a variety of fields beyond medicine, including juvenile delinquency, labor and management, the community health movement, the minorities, and addiction. 
MEANING-A REQUIREMENT FOR SURVIVAL 
The fourth frontier of logotherapy, the geographical, is the easiest to observe. The pebble Viktor Frankl tossed into the pool of human understanding has caused ripples to spread from Vienna throughout Europe, the Americas, the Orient, Australia, to the Communist lands, and the developing countries. Whatever may separate these cultures, they share the human thirst for a meaningful life, for a useful !if e that allows them to reach beyond their physical needs and psychological drives to their human longings. 
I should like to suggest a fifth frontier of logotherapy which is more elusive but possibly more important than all others together. 1 would venture the outrageous prediction that, unless some of the principles of logotherapy are practiced by at least a sizeable minority of people, not merely our health, happiness, and sanity will be threatened but our survival as a race. 
Logotherapy has been defined as "education to responsibility." What is meant here is not the responsibility that is superimposed on us by society, parents, and other facets of the superego but individual responsibility which Frankl prefers to call "responsibleness." It is not a duty forced upon us but a commitment freely taken on. 
Logotherapy assumes that there is a demand quality in life, and that we are free to respond. This freedom, which is a far cry from the freedom to do as we please, is the root of the meaningful life. It is not a freedom from restrictions but a freedom to respond to the demands of life. 
The demands of life generally have been obscure but for the first time are becoming discernible in our age of possible nuclear and ecological disaster. For the first time we see the dangers of considering pleasure, power, and material wealth as the highest motivating forces for our actions. Frankl stresses two human capacities: self-detachment and self-transcendence. We have the capacity to step away from ourselves and see ourselves from the outside, perhaps from a higher perspective, and see how ridiculously and dangerously we behave, driven by our fears and obsessions. Self-detachment is the basis for paradoxical intention, a logotherapeutic method to break disastrous behavior patterns. 
And we also have the capacity to self-transcend our egocentricity and 
include others in our considerations. Self-transcendence is the basis for the 
logotherapeutic practice of dereflection. Perhaps the time has come to 
practice paradoxical intention and dereflection on a global scale. 
It may be useful for the leaders of the world, the political parties, the 
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Joseph Fahry 
military and industrial complexes to self-detach and use a bit of paradoxical intention to try and break the vicious cycles offears and suspicions in which they seem to be hopelessly trapped. It may be useful for them to selftranscend and overcome their "hyperreflection" on power, prestige, and comfort. and include into their considerations a group of people who have never seriously been considered, namely our descendants (if any are around) fifty or more generations in the future who will suffer from the radioactive wastes we bury and from the resources we pollute and deplete for shortrange pleasures. Logotherapy is education to individual responsibleness. It won't do merely to blame our parents, our society, or our institutions. Each person. individually, is free and response-able to the demands of life if it is to continue on this planet. We arc free to decide how many children we'll have, how much gas we'll use, what the temperature in our home will be, how much food we'll eat. how many luxuries we'll buy, how much profit we'll make, how high a wage we'll demand, how much to budget for pleasure trips, and how much we'll volunteer to help others. These are decisions every one of us will have to make. By using self-detachment and self-transcendence we'll find the meaning and usefulness that now escapes us. Pleasure and satisfaction, as Frankl maintains, will come as a by-product of having found meaning. Material wealth, as he also maintains, will become meaningful when it is used for a meaningful purpose. 
I have heard two objections against such ideas: that they go against human nature, and that they offer nothing new because they are just common sense. 
As to human nature, I can only quote the German poet Goethe who is often quoted by Frankl: "If we treat a person as he is we make him worse; if we treat him as he ought to be we help him become it."2As long as we treat human beings as animals that can be trained, and machines that can be manipulated, we make them into animals and machines. If we make them aware of the resources of their human spirit we help them lift themselves into their true humanness. 
As to the accusation that logotherapy contains much common sense, we plead guilty. It is time that common sense is used, even in therapy. 
JOSEPH FABRY is executive director ofthe Institute of Logotherapy and editor of the International Forum for Logotherapy. 
REFERENCES 
l. Fabry. .Joseph. Reuven Bu!ka. and William Sahakian. eds. Logotherapi· in Auion. New York. Jason Aronson. 1979. 
2. Frankl. Viktor, Psych()(herapy and ExiHentialism. New York. Washington Square Press, 1967. page 12. 
3. Wirth. Arthur. "New Directions in Schools." in Logotherapl' in Acrion. Fabry. Bulka, and Sahakian. eds. New York. Jason Aronson. 1979. 
II 
FIRST WORLD CONGRESS OF LOGOTHERAPY 
Dr. Viktor E. Frankl, founder of logotherapy, giving the keynote address on 'The Future of Logotherapy" at the First World Congress of Logotherapy, held November 6 to 8, 1980, in San Diego, California. 
The Congress, which was sponsored by the Berkeley-based Institute of Logotherapy, signaled the establishment of logotherapy as a movement devoted to academic and theoretical research in addition to the continuing training, educational, counseling, and information programs provided by the Institute. 
The First World Congress attracted 187 registrants from 10 European, Far Eastern, and American nations, with especially large contingents coming from Mexico and Brazil. The 34 sessions offered 16 panels with formal paper presentations, IO conversational contact sessions, five workshops, and three symposia. 
The papers presented at the Congress will be published in a book, Analecra Frankliana. Orders will be received by the Institute of Logothcrapy, I Lawson Road, Berkeley, CA 94707. 

7 he International Forum for Logothcrapy Vol. 4. 'io I. Spring Summer 1981 
New Ways for Dereflection 
Elisabeth Lukas 
Self-observation is healthy but in excess may become harmful, even pathological. Paying undue attention to normal physical activities such as sleep, sexual intercourse, or even walking or talking may result in insomnia, sexual dysfunction, stumbling, or stuttering. 
Once it has been established that the disturbance has no physiological causes: it may be assumed that its roots lie in what Frankl calls "hyperreflection" and "hyperintention." The clients' exaggerated self-observation must be reduced so the automatic functioning of their body can be restored. It is difficult, however, to get a person not to think about a troubling disturbance, e.g. about potency in situations when sexual performance is expected. The most practical way to ,prevent clients from thinking about their trouble is to make them think of something else, to "dereflect." 
To some extent, dereflection resembles autogenic training where the deep relaxation is achieved not merely by autosuggestion but also by the fact that the rhythmically repeated formulations shift clients from brooding about their problems. Because the formulations have a suggestive force, they must be directed toward positive goals. 
Dercflection can be applied in a wide variety of situations. I once used it to help a high school student overcome his severe anxieties in school. Anton was highly intelligent and should have easily passed his tests. But when it came to examinations he concentrated his attention on his fear that he might have forgotten all he knew, and indeed he did poorly. 
He also developed the typical psychosomatic stomach disorders which 
often are found in nervous students. Actually, the problem was not really a 
disturbed body function which should have operated automatically, unless 
one considers the ready recalling of learned material a body function. 
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N cvertheless, I decided to try dereflection and suggested the following plan to his parents: For three months the topic "school" should be avoided; instead, Anton's free-time program was to be enriched. He was to be allowed to join a soccer team requiring two practice sessions a week, and games on weekends. He also was permitted to join a choir as he had a good tenor voice and liked to sing. His electric train, which was set up in the small apartment only during holidays was made to operate during the school season. He was encouraged to take books out of a library and read what he wanted. For the weekends, outings and picnics were planned. 
The parents were skeptical. They were afraid that, with so many outside activities, Anton's average would drop even lower in class. I, too, asked myself if dereflection would work in this kind of a situation. 
His parents cooperated beautifully. Whenever Anton began talking about school. they asked him about last night's choir practice, about his soccer games, or about picnic plans. After a few weeks the changes in the boy were apparent. He was lively, interested, and the more he became involved in his extra-curricular activities the more he forgot about his anxieties. 1 was certain of success when his mother told me after nine weeks that Anton had come home from school and during mealtime suddenly said, "Today we had a math test; I should have had a bcllyache~but I didn't think of it." 
After half a year, Anton's grade had improved from a C average to A-minus. 
This case confirmed my suspicion that the possibilities of dereflection were by no means exhausted by the kinds of cases generally described in the logotherapeutic literature, and that there still was room for much experimentation, improvisation and exploration. 
When I began to explore the possibilities I ran into a roadblock. Dereflection, although a specifically logotherapeutic technique, clashed with a basic logotherapeutic principle; namely, the honest, personal relationship between counselor and client. Clients are not to be manipulated. They are to be fully informed about the processes in progress so they can become partners in the common search for meaning and health. It remains the clients' responsibility to take charge of their lives and use the armory of logotherapy to achieve their goals. 
When applying dereflection, however, it is not possible to keep the clients fully informed about what the counselor intends to accomplish. When clients are told not to think about their problems but rather of something else, the dereflective purpose is lost because the instruction not to think about their problem draws attention to the very thought from which they are supposed to dereflcct. This dilemma can be resolved by methods that come close to "trickery." In the classical case of sexual dysfunction, for instance, an impotent man may be told that his partner must not have sex while taking 
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Elisabeth Lukas 
some medication, but he is allowed to be with her in intimate situations. At the same time, his partner is told to let nature take its course when she sees he is ready. No longer beset by expectations from his partner, himself, or the situation, he is dereflected and the normal functions of his body again become unblocked. 
THE ALTERNATIVE LIST 
To reduce the "trickery" to a m1mmum I am using dereflection by alternative lists. And I have expanded the application of dereflection beyond the classical cases of insomnia and sexual dysfunctioning to a variety of cases including depression and fear of failure. 
First, I explain to my clients the connection between their symptoms and their brooding about them. We agree to work together on a scheme to reduce their hyperreflection. This assures me of their cooperation. 
Next, I suggest they think ofdesirable, positive, and healthy activities that might enrich their lives. They are to make a list of such activities. I am available for suggestions and help with the list. The clients are also asked to write down the circumstances in which their problem seems acute and when they could try alternative activities. 
Third, they arc told to select one of these activities every time they are likely to hyperreflect. Only during this phase do the purposes of counselor and client diverge. The clients are told to try out their chosen activities, supposedly to determine their later use in therapy. In reality, this "preparation" for therapy is already therapy ( dereflection). 
The clients require some time to test their alternatives. This is valuable healing time during which attention to the problem is replaced by attention given to the testing of alternatives. The symptom is "neglected," although the clients hardly notice that the trouble subsides. 
When the clients finally decide which of the alternate activities could be 
used for dereflection, dereflcction has already taken place. They have proved 
to themselves that they are not the helpless victims of their depressions, 
fears, or whatever other problems had occupied their minds. They have 
broken the pattern that seemed unbreakable, and gained distance from their 
symptoms. They have changed their self-image from "I am a depressed 
person," "I am a failure," or "I am impotent," to "I am a human being who 
has experienced depressions, failures, or impotence." They see their prob
lems no longer as intrinsic parts of their person but rather as experiences 
they have acquired and from which they can free themselves. 
The results, including the new self-image, may have to be fortified. Some clients have to be encouraged to continue with an alternative activity, and 
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this may lead to new and fulfilling interests. Others will decide they no longer need the detour of the alternate activities which they consider "childish." A Socratic dialogue will help them find their own short-range and long-range goals. 
The following case illustrates the application of dcrcflcction through alternative listmaking. Martin S, 41, had been depressed and apathetic since his wife left him and their 15-year old son Tom. Although the marriage had left much to be desired, Mr. S was full of guilt and self-doubt, brooding over such questions as why did his wife leave him, what had he done to drive her away, and what could he have done to prevent the break-up. During the day, at work, he functioned normally ("We arc very busy at the shop") but at home he sat for hours, staring holes into the air. Occasionally he was overcome by weeping he could not stop. Tom, meanwhile, had run away from home several times, and had been brought back by the police. The youth authorities decided to have him sent to a boys' home, and wanted a psychological appraisal which, they said, was a matter of routine because "the case was clear-cut." 
An extensive interview with Tom disclosed that he had run away because his father was inaccessible to him, and he felt lonely and unhappy. Still, he loved his father and refused to go to an institution. I then asked to see his father. 
Fragments from Our Talks (Abbreviated) 
I: (Dr. Lukas): Mr. S, Tom tells me you still.feel bad about yuur wife's leaving you. 
S: That's right. 
I: It's been half a vear. Du ruu think vou can overcome rour sorrow? 
S: I don't thi~k s~. It's getting wors~. And now they'll. take away my boy. (He weeps). 
I: (after a pause): Mr. S, in my work I see a lot ofpeople in pain. 5,ome are/acing severe grief and still are able to function. Others break down at the smallest problem. 
S: Not everyone has the same strength ... 
I: True. That's why I would like to propose a plan. Ifyou don 'tfeel strong enough to face your pain, maybe I can help. 
S: No one can help me. How do you want to help me? 
I: I cannot undo what happened. But I'm trained to help, and would like to help you, too. I offer you all my knowledge and my caring in support ofyour own strength. I don't know if we hoth will be strong enough to defr your depression, but we can try. 
S: I know you mean well, but I have no hope. I often told myself to pull myself together, but I can't do it. I just can't do it! 
I: 
We can do it, together. Think about it and tell me tomorrow ifyou want to try. Next day: 

I: 
Well, Mr. S, how do you feel today7 


S: I came ... I'd like ... to try. (Embarrassed) Tom said to me: "You know, dad, the woman, she'll help us." 
16 
Elisaheth Lukas 
I: I'm really glad. Tell me, what would you say is the worst thing about what happened with your wife? 
S: What do you mean? 
/: Well, what would you say is it that weighs you down: that your wife left you, and the anger and disappointment this caused you; or the consequences ofyour wife's leaving-the loneI}' evenings, the fuss ofcompanionship, the undivided re~ponsihility for your child? 
S: You know, our marriage was not all that good. My wife was so different from me, we never were really a good match .... (he tells about his marriage). No, it's more the consequences, the evenings alone. I always keep thinking why did it happen, I just can't shake it off. 
I: Tell me more about that. How does it start? 
S: I don't know how. Suddenly it hits me that she i~ gone, that she'll never come back, whether I could have prevented it -my thoughts circle around these questions like moths around a flame, I cannot do anything against it. 
/: And these thoughts prevent you from doing anything? 
S: Exactly. I think that nothing makes sense, whatever I do ... 
/: And as long as you du nothing hut think these thou1;hts, you feel paralyzed? 
S: That's right. The brooding seems to fill every corner of my self. I have to make a great effort to do even the routine things that are necessary to go to bed. Only my sleep rescues me. 
I: Then you would say that you could bear the end ufyour marriage ifyou were not overcome by these unhappy thoughts that choke offyour stren1;th to 1;0 on with your life? 
S: Yes, I believe that's true. I didn't see it so clearly but you might be right. If I didn't have to think about it, day after day, I might be able to overcome it. But the thoughts cannot be controlled, they come by themselves. 
/: During the day, when you are at work, they don't come? 
S: Strange, then they don't come. We are very busy now, before Christmas, at the shop. 
I: And there you feel better about yourself than at home? 
S: Yes, that's true. Do you think I should work overtime? 
/: Perhaps there are other things than work that can divert you from your brooding. Can you think of something? A hobby,? Music? Sports? Games? 
S: All these things mean nothing to me now. 
I: Did you have other interests before your w/fe lefi you? 
S: Well, when I think of it (he hesitates) there always was something to do. I cannot pinpoint it, some job in the house, nothing special ... 
/: You didn't have the time to go after your own interests? 
S: Yes, of course, that's the way it was. 
/: But now you have more time. The time you spend brooding really is free time, isn't it? You could use it to go after your interests. 
S: I can't. 
I: You could do many things in this time, also thin1;s together with Tom, ifyou were not blocked by your unhappy thoughts. We would have to.find something that is stronger than your thoughts, something that interests you, that you enjoy and that diverts you from thinking about the past, something that opens new possibilities for the future. Something strong enou1;h so you can use it as a weapon against that destructive brooding ofyours. (Here I attempt to help Mr. S gain distance between himself and his symptoms) 
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International Forum for Logotherapy 
S: A weapon, that sounds as if ... Isn't it a weapon against myself7 I am the one who is doing the thinking, and I cannot forget, not even if I do something else. 
/: No, it's not a weapon against yourse(f It's a weapon againsl your suffering. But suffering need not produce more suffering. First, your w(fe left you; !hat broughl on your lonely evenings, and now they want to take Tom away.from you. Bui you don't have lo give in. You can use your suffering as a challenge to become s/ronger so you can overcome it. 
S: The way you say this -I really wish I could do that. 
I: You only need a little patience and a little trust. Try to imagine all the lhings you could do to spend your evenings in a meaningful way. Whal could you do? 
S: Well, I can imagine things, but I can enjoy nothing. 
/: That doesn't malter. For the time being we'll just make a list of your personal interests, activities, hobbies, or experiences that you could try. Let's both work on this list, and then you can test which one of them you might use as a "weapon" against your compulsive and unhappy thoughts. 
S: We won't find anything. 
I: Perhaps you expect too much. A meaningful activity for the evening does not mean thal you have to forget your wife. On 1he contrary. You probably have some good memories about your marriage, and those you should keep alive. You don't have to erase the past, bu/ you can live with and in spite of your memories. What, then, would you list first for an activity., 
S: (after a long pause): What I once would have liked to do ... well, to set up a technically perfect electric train -that sounds childish, doesn't it? 
/: Not at all. That's an interesting projecl. Do you have !he parts.'' 
S: Yes, much of it is in boxes in our attic. We probably would have to buy a few more items. Somehow there was never time for it ... 
During the next three sessions we put together a list of fifteen possible activities for the evenings and weekends. Despite his initial apathy and doubt he began to sec a certain amount of fun in our "game," but he repeatedly insisted that he couldn't imagine that this could in any way help him overcome his problems. After finishing the list Mr. S received the following instructions: 
/: You thought up a nice list of interests and here it is all writlen down. I am adding a rating scale next lo each item, like this: 
Set up electric train -2 -1 0 +I +2 Go to sauna -2 -I 0 +l +2 Help Tom with homework -2 -I 0 +I +2 Listen to the hit parade on radio/ 
TV and make tape recordings -2 -1 0 +I +2 Prepare salads and mayonnaise -2 -IO +I +2 Take apart and repair old kitchen stove -2 -IO +I +2 Grow cacti from seeds -2 -IO +I +2 (And so on) 
Now I need your cooperation.for the next 15 days. Every nigh! when you come home from work, select one ac1ivi1y listed here and work on it continuously until you go to bed, without interruption, even ifyou think it's useless and won't bring you any relief Keep it up, onlr for 15 days. On Saturdays and Sundays select 
18 
Elisaheth Lukas 
something that takes more time, the train or the stove. Before you go to bl'd, mark on our scale how rou.feel. Plus 2 when you.feel very satisfied, O when you.fed soso. and -2 whl'll you feel had. A_/ier 15 days we'll have a good idea about which activities work wellfor you and can he used later in our therapy. Will you do this:' 
S: I guess I can do it for 15 days if you think that's important. But I can tell you right now, I'll mark nothing but minus twos. 
I: That's all right. Be honest and mark just how youfe!'I. The important thing is to keep it up. If you have difficulties, call me. /'II always be readr for you. 
(Six days later) 
S: I just wanted to tell you, last night when I went to bed I felt good for the first time in a long while. Tom and I had worked on the train, and close to midnight we were so tired we could hardly keep our eyes open. But you can't imagine how happy Tom was. And I had hardly thought of my troubles. Only when I brushed my teeth I realized that it's only a game and that I still had to mark the list. But the first three days were terrible, I had to force myself, 1 wanted to quit and went on only because I didn't want to disappoint you. 
/: I am glad that you were success/iii in keeping it up. 
S: I am calling you to ask if I really have to try out the other things. I know now that I like to work on the electric train, there still is much to do, and I could work on it occasionally, maybe that alone will help me? 
/: I can understand that hut do go on the wa_v we have planned our program. You'll have plenty of time to finish the train, hut it is possihle that some other activities also would give you pleasure, and that's why I'd like you to trr them all out. Keep it up. not _/11r my sake, not even for your own sake, hut for the sake of Tom. 
On the eleventh day Mr. S called about various details -when should he mark the 0, couldn't he skip a day, he was a little tired and didn't think it necessary to go through the list item by item, he was pretty sure which activities interested him and would be helpful in the future. He never mentioned his thoughts or worries concerning his wife. 
I 
At the conclusion of the experiment, on the 16th day, Mr. S presented the following list: -I 0 +I +2 Negative 
-I 0 +I +2 early phase 
-1 0 +2 
-2 EJ) 0 -2 -I 0 -2 -1 0 -2 8) 0 
-2 -1 0 +l Process of healing -2 -I 0 through dereflcction
ED
@) -1 0 +I +2 
f 
-] 0 12
+I
-2 -I 0 +I +2 
-2 -I 0 +] +2 Positive -2 -I 0 ED +2 final phase -2 -1 0 +I@ 
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International Forum for Logotherapy 
I: Mr. S, I congratulate you to your success. You wouldn't have expected to get that many plus marks. would you? 
S: That's right. I never would have thought that's possible. Now we know what activities suit me best. 
I: We know more than !hat. Just look at the hvt. During the past.five days you had nothing hut pluses. Do _rou think that was the result of a special activity? 
S: What do you mean? 
/: Some o('rhe pluses came after working on the train. Others afier making a salad, or after working on the stove, or helping Tom with his homework. Didrnu think of your trouhles:1 
S: Well, I hardly had time for that. Working all day, and doing these things at night, and then scoring them ... 
I: And brooding ahout your wife, that would have been askinx too much, wouldn't it_? (We both laugh). You have gained strength through this proxram which you carried out so valiantly, Mr. S, a lot ofadditional strength. You hai·e conquered your trouble.' Now let them come, aff these thoughts ahout your wife. Invite the thoughts to visit you at night, they no longer hai•e power over you, _i·ou are armed to meet them, you have a whole fist ofweapons against them. (Using paradoxical intention and reinforcement by suggestion). Why hother to sit in a corner in despair, overpowered by a sad thought I Ifyou feel like that again, then make one of your magnificent salads, or build a tunnel for your train, or tape-record a program you like, and _1·ou wiff realize how strong _vou ha1•e hecome, how much inner peace you have gained. 
S: And you think I won't have a relapse? 
!: Oh, you can afford a IiIlle relapse, now and then. You have gone through difficuli times but you have proved to yourself that you have the strength tu overcome them. The suj/ering you have experienced has made you strong. During the next week try and do what is fun for you, without a schedule or aclivities, and you wiff see that you don't have to do things, you can occasionaffr take a rest without being overwhelmed by trouhling thoughts . . 
In the follow-up session Martin S said that he had overcome his depression even though he had finished the projects that were to guide us in therapy: setting up the train and repairing the stove. Hy asking him to think of activities that would be a clue to therapy, therapy had become unnecessary. The defiant power of his human spirit had been aroused and helped him find a meaningful direction in his life as a single father. 
A young psychiatrist who had observed the case raised the question of whether the success was due to the method of dereflection or my personal caring. I pointed out to her that in logotherapy methods and caring are so interlinked that an either/ or question cannot be answered. 
In dereflection the counselor helps clients find goals or tasks which capture the clients' total attention so they free themselves from a fixed and unhealthy attitude. to a new lifestyle. 
DEREFLECTION IN MEDICAL MINISTRY 
Dcreflection is also applicable where medical help no longer is possible, as 
20 
Elisabeth Lukas 
in cases of incurable sickness and dying. In the face of death all psychological methods lose their significance. There arc few words of comfort a healthy person can say that will reach the dying. But the possibility exists up to the last moment to dereflect the thoughts of the dying from their impending death onto the meanings of their lives, their past accomplishments, which no one can take away from them. Here dereflection is reinforced by a modification of attitudes, away from feelings of futility to those of achievement. In this extreme situation the entire spiritual potential is mobilized so the inexorable fate becomes transformed into a splendid human achievement of which the client can be proud up to the last breath. 
Similarly, dercflcction can be used for patients who suffer from symptoms whose causes cannot be eliminated, such as some psychoses, attacks of epilepsy, organic deficiencies, and even endogenous depressions. Patients wait for their attacks, constantly observe themselves for signs of symptoms, or arc preoccupied with the state of their mood. It is important to counteract this hyperreflection, even when the symptom cannot be removed. 
In cases of endogenous depressions Frankl proved that patients may be suffering from what he calls "piggyback depressions," secondary depressions which "ride piggyback" on the primary depressions. In such cases the endogenous depression, caused within the patient's physical dimension, is now joined by a second depression that originates in the psyche: the patients are depressed about their being depressed. In some cases one can see how patients weep about their tendency to weep, and are sad about their sadness, and thus reinforce their depression. The dereflection enables such patients at least to free themselves from their "superimposed" depression and to reduce their suffering to the level that is unavoidable. 
Dereflection, which counters hyperreflection and hyperintention, requires a different plan of treatment than paradoxical intention which counters phobias and obsessive compulsion. Paradoxical intention begins with a selfdistancing from one's symptoms, followed by a change of attitude, a reduction of symptoms, and the discovery of meaningful activities and ex penences. 
In dereflection the fourth step comes much earlier in the treatment. The 
patients are helped toward finding new life content that dcreflects their 
attention from their unhealthy preoccupation with a problem. But before 
this goal can be achieved, it is necessary to expand their attention toward a 
wider field of meaning potentials than self, to arouse their capacity for self
transcendence, the reaching out toward someone to love or a cause to make 
their own. 
If the therapy succeeds in freeing the clients from their fixed focus on self 
and guiding them to a meaningful object outside, the symptoms become 
more manageable and often disappear. And as soon as the clients have 
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International Forum for Logothcrapy 
experienced the healing power in self-transcendence, their attitude begins to change. 
The four steps of a treatment plan using dereflcction, therefore, tend to have a different sequence from that used in paradoxical intention and most other methods of logothcrapy: 
1. 
Self-transcendence. 

2. 
Finding meaningful tasks and goals. 

3. 
Reduction of symptoms. 

4. 
Change in attitudes. 


Self-transcendence is more than mere dereflection, it presents a direct contrast to that most difficult of all psychological sicknesses, egocentricity. Persons who think of nothing but their own well-being will always detect disturbances and symptoms, and no one will be able to cure them completely. True human happiness lies in the ability to forget oneself. This truth is hard to communicate to today's men and women who arc inclined to be self-centered. That makes dereflection one of the most difficult, yet most important, therapeutic methods. 
When the self-pitying clients come for a consultation, their initial position is: "You are here for me. You must help me." Slowly and cautiously I try to guide them to ask themselves the question: "And for whom am I here? Whom can I help?" I measure their sickness by the rate at which they go into their stories and amount ofdetail brought in. The crisis exists as long as the clients spend much of their time to think about their symptoms with no word about partner, their children, friends ... Once they switch to: "I have no time now (or no desire) to talk about my silly symptoms," they are on their way to overcome these symptoms. 
COMBINATION METHODS 
Both dereflection and paradoxical intention can break an unwanted behavior pattern in which clients feel trapped. Both methods make them aware, even if only for one moment, that they are not victims but masters of this pattern. 
To decide which of the two methods is most applicable, the counselor must distinguish between cases dealing with abnormal conditions, which the client fears (stuttering, excessive sweating), or normal conditions which the client wants to force ( sleep, orgasm). 
Abnormal conditions which the clients fear are best treated with paradox
ical intention. For normal conditions which are blocked by hyperreflection, 
dereflection is indicated. The following table illustrates the applicability: 
22 
Elisabeth Lukas 
Paradoxical intention -prevents ----.-an event or a condition (fear) Dcreflection------brings about-an event or a condition (sleep) Change of attitude ---helps master -anevent or a condition (incurable 
sickness) Self-detachment----.-helps apply ---. paradoxical intention Self-transcendence----helps apply ---. dereflection (Auto) suggestion helps bring about-change of attitudes 
In cases where a combination of both methods is indicated, it is better to liberate the client first from the grip of anticipatory anxiety (through paradoxical intention), and then to remove the blockage of hyperreflcction (through dereflection). The following case will illustrate how the combination may be applied. 
Mrs. F. for years had suffered from a severe phobia of air trams. Her husband was a photographer specializing in mountain views. They used their vacations to ride up the mountains for spectacular views and motifs, taking various air-tramways or gondolas to reach the heights. Mrs. F actually loved to accompany her husband because she enjoyed arranging photos for calendars, yet she had a phobia about using the floating cabins. She didn't mind the chair lift so much because in that type she felt less closed in, and the trips were less steep than those using large cabins with many people. 
Formerly she had gone up on foot and met her husband, who used the air-tram, on top of the mountain. But gradually she found the hike too strenuous. She had gone for years to psychiatrists and tried out all kinds of medications. One of them enabled her to use the air-tram once in a while, enduring palpitations and dizziness, closing her eyes and holding on tight to her husband. Mrs. F came to my o!Iice in January and confessed that she already was dreading the thought of summer and wondered whether she wouldn't do well to just remain home while her husband went on his mountain trips. I offered a counter-suggestion. Since we couldn't practice our therapy out there in nature, she might try something in town. During this half year before the summer season I would train her in some techniques to use so she would find it unnecessary ever to visit a psychotherapist again; she herself would be able to overcome her fear. 
We used our time well. In all sorts of enclosed car and train situations we kept practicing paradoxical intention. A bus became an air tram and Mrs. F worked on progressive muscle relaxation combined with elements of autogenic training; one variant was used for quick relaxation. Then we worked out little tasks to do to keep busy in a closed area, such as difficult crossword puzzles and writing letters. We would go on short stretches sitting in a streetcar and she chose the appropriate reaction to use as wc covered distances connected with mountain areas in our imagination. 
Work Agreement 
Together we take a train. 
Question: How will you use your time before entering the mountain train? 
Answer: I resolve firmly to enter this contraption with immense heart palpitations. After all, I want a little excitement for my money. 
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International Forum for Lor,otherapy 
Question: What about your eyes" 
Answer: Of course, they'll be open, otherwise I would miss the opportunity to get the most beautiful attack of dizziness, it's like being dizzy from champagne, I tell you! We enter the train and sit in our compartment. 
Question: That's a had time, this waiting, im't it? 
Answer: Oh, not at all. 1 have my book of puzzles to keep me busy. I made a bet with my husband that this puzzle will be finished without any errors when we get to the top. He doesn't believe it, but I'll show him. The winner of the bet gets a silver pin: he for his cap, or I for my jacket. 
The train starts moving. She works on her crossword puzzle. Question: This air train is getting a little shaky and you're starting to feel that funny feeling; will fear take over? Answer: Fear won't take over; it would like to, but it won't succeed. See, 1 have something I can do against this funny feeling: I'll clench my fists, tense up, and hold the tension -slowly relax, enjoy the feeling of rclaxation~-enjoy it a little more now and feel restfulness and relaxation going through both hands. Next, I press the knees tightly together, still tighter, just a little more-and now relax the knees. that's pleasant, I can feel the warmth in my knees-this warmth envelops my whole body -and now I breathe deeply, breathe in, hold it, hold my breathand slowly breathe out-feels good, this sense of relaxation and feeling the warmth and peacefulness -it breathes me. quietly and evenly, quietly-evenly am I being breathed through no effort-enjoying the relaxation-relaxing even more deeply and now if I look at the crossword puzzle I feel fine again I come up with a solution-I'm looking right now! Question: We're arriving at the mountain station. You put the puzzle book away. What now? Answer: I feel proud, I'm filled with pride. I can look through the window. I am here on top. I can take it, come what may. Let the whole contraption fall into the abyss, I dared look out the window. I really made it all by myself, I dared it and made it. Let the whole gondola spin around its axis -that would be fun. I look out the window in spite of my fear. The train stops at the station and we step out. Question: Now you are getting out of the air tram. Couldn't you get a little scared now that it is over? Just a tiny weensy bit? Answer: I left the fear in the gondola. Why should I take it along? Some other passenger may want it, make friends with it. The gondola is still here and did not fall down. My heart is still here and didn't explode. Too bad, I would have liked some excitement. Nothing ever happens on these trips. Oh dear now I remember: I didn't finish my puzzle. Well, I can work on it some more on our return trip. I'm looking forward to it. But the pin goes to my husband. Shucks! 
In this case the following methods were employed: Medication, beforehand. Paradoxical intention (before possible anticipatory anxiety). Dereflection (to bridge difficult time spans). Self-relaxation (in emergencies). Activating the defiant power (at a point of relatively high security). Reward: Pride in accomplishment. Paradoxical intention again: to avoid relapses. 
24 
Elisabeth Lukas 
In between, repeated distancing of self from her fear. 
Armed thus, our patient went on her vacation. After a week I received a postcard with a lovely mountain motif. "Dear Dr. Lukas: 1 finished the crossword puzzle, and before I begin flirting with my fear, I'm writing you a few lines. Yes, I'm writing you from this air tram, writing on my husband's back, with my eyes open. He can hardly believe it. Isn't that something? Aren't you surprised, too?" 
HYPERREFLECTION AND MEDICATION 
Hyperreflection may also present a problem when, in the course of the therapy, medication is used to stabilize the patient. When medication is withdrawn, patients often suffer relapses, and not just because the pharmaceutical effect has ended. Two kinds of withdrawal symptoms come into play: a physiological withdrawal symptom because a chemical dependency was established, and a psychogenic withdrawal symptom because patients, after medication has ended, may observe themselves anxiously (hyperreflection) to see how they feel without the medication, which produces anticipatory anxiety and opens the way for the relapse. 
To avoid the consequences of a sudden termination of medication, it is possible nowadays to manufacture pills which look alike but contain different amounts of the medication. In the course of the therapy, patients can be given pills which contain less and less of the medication without their being aware of the reduction from, say, 40 per cent to O per cent (placebo). When the use of pills is discontinued, the patients are told that for the past two weeks they have taken only placebos which proves that they no longer need medication. This gradual reduction minimizes the physiological as well as the psychogenic consequences of the withdrawal because the patients now realize that they have felt good although they have swallowed only sugar during the past two weeks. 
Suggestion plays its part in therapy, even if suggestions arc only implied. 
Ineffective medication (placebo) may have positive results, and the sudden 
termination of superfluous medication may affect patients negatively. The 
therapist must always consider the feedback mechanism and its effect on the 
patients. She must also take into account the dimension of the human spirit 
by summoning its resources, including decision making, responsibleness, 
and the will to meaning. 
Whatever one may say about the techniques of logotherapy, one thing is 
certain: it is not persuasion. The more the therapist tries to persuade patients 
to change their attitude about a problem, the more they are likely to defend 
their identity within their condition of illness. Any persuasion only enforces 
the resistance against a moving away from the symptoms. 
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International Forum for Lof.;otherapy 
EXPANDING THE MEANING HORIZON 
An unhealthy hyperreflection is dereflcctcd to a specific healthy targetthe impotent man to his partner; the depressed Mr. S to his list of fifteen activities; the phobic Mrs. F to her crossword puzzles. Behind these specific targets, which patients choose according to their preferences, lies a general expansion of their meaning horizon. Nothing protects a person from neuroses, psychoses, depressions, and psychosomatic illnesses as much as a task, a goal that can pull the patient from sickness to health. In a Socratic dialogue the logotherapist can elucidate a variety of activities and experiences-work, play, hohhies, sports, art, friendship, family-which the patient found meaningful in the past and now has forgotten, ignored, or discarded as no longer applicable; or, equally important, activities and experiences that have appeal to the patient for the future but arc rejected right now as hopeless. A widening of the meaning horizon is often the most solid foundation for therapy. 
Hidden behind the problems that prompt patients to seek counseling frequently lies a hyperreflection on hopelessness. When clients are dereflected toward new meanings or goals, the symptoms, usually depression, become bearable or disappear altogether. One of the most widespread causes of depression is a feeling of uselessness. Behind the depression lies the oppressive question: "What am I good for?" Not only older people suffer from this existential doubt, but also persons in midlife whose children have grown up and whose career and possibly marriage have grown stale, and the young who are undcrdcmandcd and victims of a reductionistic, hedonistic, and success-oriented society. 
Most depressed patients come with a ready-made and negative response. They do not ask "What am I good for," but state, "My life is not good for anything." The therapy, especially for older people, must begin by helping them dereflect from such negative attitudes and toward the still open question of what meaning their life might yet have. Sometimes going into their past helps them locate threads of meaning that went lost during the years of parenting or professional work. Socratic questioning is an appropriate method to rediscover old goals and elucidate new ones, and make people realize that their life has not become a dead end. 
Mrs. W, a 55-year-old widow, lived alone since her four children had married. She suffered from an endogenous depression which occurred in a two-year rhythm, and she was in danger of a noogenic depression in the interim periods. To avoid the additional depressions it was necessary to widen her meaning horizon. I let her describe everything that had filled her life in the past. She told about bringing up four 
26 
Elisabeth Lukas 
children during and after the war. sewing their clothing hy hand. knitting sweaters to supplement her widow's pension, making the toys for the children herself. "Didn't you once in a while wish to do something else. heyond this daily routine?" I asked her. Smilingly she rememhered that she had always wanted to work on needlepoint pictures for her wall. but the material was expensive and there was never time. I urged her to think about other things she had dreamed ahout, with no chance of realizing them. "Embroidering," she remembered. "That would have been so much more fun than sewing the tough material during war times. And my stamps. My father left me a whole carton of them, and I never got around to sorting them. I would have liked to have pen pals in far-away countries, I would have received letters with strange stamps. Yes, I would have liked to do things leisurely--embroider, examine my stamps through a magnifying glass, also work with wax-but all this is a dream-life has passed by so fast." 
"Your life has not passed," I told her. "It_just has changed." "You no longer need to dream about the things you wanted to do. Now you have the time to do them. Time has been given to you as a reward for working so hard. You are still healthy and able to do the things for which you had no time before. And you let this precious time slip by. Accept your reward and use the gift of time, it will bring you fulfillment. You never thought of yourself, you always worked for your family, now you have earned the right to think of what you want to do, even if you arc not used to it. Why shouldn't you work on a needlepoint picture, now that you can afford the material and have the time'1 Why not sort out your stamps and swap with others to complete your collection'1 Lots of people want to become pen pals, students who want to brush up their German by correspondence. You can help them and at the same time reshape your life. You no longer need to sew clothes from coarse materials, you can buy them readymade from soft and beautiful fabrics. There is no need to keep house for your children, you can use the time to do all the things you missed." 
Mrs. W understood all this and admitted that she had never viewed her life from this perspective. She finally began to work on needlepoint pictures and made one for each of her children, then one in memory of her husband, a mountain scene he loved, which she hung in her living room. The enthusiasm about her work pulled her through and away from her depressive tendencies. 
The widening of the meaning horizon is the most essential part of the logotherapeutic treatment program. It often is the culmination of the program, a common search of counselor and client for activities and experiences that are meaningful for the client. Once the client has indicated a possible direction, the counselor can support it. The counselor may suggest possibilities but never impose a direction on the client. 
The finding of meaningful goals and tasks, which usually is the last step in logothcrapy is often the first step in the treatment using dereflection. Here, meaningful activities are not merely the ultimate goal of the therapy but therapy itself. The clients are dereflected from depression, pain, traps, selfcentcrcdness, and self-pity to activities and experiences that are meaningful to them. They arc diverted from their problems instead of anxiously 
27 
International Forum for Logutherapy 
watching them, and therefore their symptoms become bearable, and often diminish or even disappear. Attention is focussed from "What's wrong with me?" to "What's right with me?" and a new and healthier self-image is achieved. 
1:.:LISABETH l,UKAS is the director of a counseling center in Munich, Germany. This article was translatedfrom the German by .Joseph Fabry. It is part ofher new book, not yet available in English, "Auch Dein Leben hat Sinn." 

Dr. Paul Polak 
We were saddened to hear of the passing of the Viennese neuropsychiatrist Paul Polak, M.D., who died, at the age of 74, after a long, painful, heroically borne illness. 
The staff of the International Forum for Logutherapy is proud and happy to have had occasion to publish, in its third issue, an original article by this prominent logotherapist. For more than forty years, Dr. Polak was Dr. Frankl's closest friend as well as his earliest co-fighter in support of logotherapy. At the same time he always kept~despite his enthusiasm for logotherapy a critical distance. Dr. Frankl often called Dr. Polak "the critical conscience of logotherapy." 
As a pioneer in his own specialty, Dr. Polak was made director of the first psychotherapeutic outpatient clinic which was ever established in Austria, the birthplace of psychotherapy. for patients covered by health insurance. In 1949. he became the first among the fifteen authors who have written books about logotherapy. In the same year he also became the author of the first scientific paper about logotherapy ever to be published in an American journal, the American .Journal of Psychotherapy. 
28 
International Forum for I .ogotherapy Vol. 4. No. I. Spring Summer 1981 
Logotherapy: New Help for Problem Drinkers 
James C. Crumbaugh 
Of the many new fields in which logotherapy is finding special applications, one of the most important is drinking and alcoholism. In America today there are roughly (statistics vary, but the numbers continually travel upward) about 9,000,000 problem drinkers, of which about 3,000,000 are hard core and intractable to any known treatment.No therapeutic approach succeeds with all of the remaining, but many approaches offer some help. 
For over twelve years I have applied logotherapy to selected patients from this 6,000,000 category in an Alcoholism Treatment and Rehabilitation Unit of a Veterans Administration Medical Center. Results have varied, as would be expected. Some patients appear to be altogether uninfluenced, while others show evidence that logotherapy was the turning point which became the key to a new and infinitely better life without alcohol. Some of the latter have returned on visits or have written years later to proclaim this fact. Not a few have become alcoholism therapists themselves: their new meaning and purpose in life has been to help other alcoholics. 
MOTIVATION 
What is the secret factor in determining whether a patient will be uninfluenced or changed greatly by logotherapy? All of the objective factors which I first thought important have proven to be poor predictors of success. But one thing I have learned: The key lies in one word, motivation. The problem is to predict who really has the genuine motivation to beat the alcoholism game and to build a new life, and who is feigning this motivation for some secondary gain (such as to receive some pension benefit or to maintain a job). 
A chaplain friend of mine questions logotherapy because he says you cannot supply motivation to those who don't already have it. I could not agree more. But logotherapy can help an individual who is motivated to find motivation-who wants a real meaning and purpose in life which will furnish the motivation to go on in the face of whatever happens, but who has not yet perceived how his life experience can yield such a motivating goal. 
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Logotherapy is a process of working with such individuals, not in determining meaning for them, but in showing them how they really do have the capacities within themselves to find this meaning for themselves. 
These arc the individuals who respond well to logotherapy, and those among them who have turned to alcohol as a cop-out from facing a meaningless and boring life are the alcoholics who can be helped by it. The problem is locating them. because in spite of the attempts that have been made to measure motivation (such as Cattell's Motivational Analysis Test), there still arc no good methods of assessing this quality. 
I have tried to deal with the problem through the development of attitudinal scales. The first scale was The Purpose in Life Test (PIL),2 to measure the degree to which the subject has found a life purpose. Later I devised the Seeking of Noetic Goals Test (SONG)1 to measure the strength of motivation to find such meaning. It was believed that a combination of a low PIL score (lack of life meaning) and a high SONG score (strong motivation to find meaning) would predict the good candidates for logotherapy. To some degree this has proven true, but there are many individual exceptions. 
All "self' tests, even the classical Minnesota Multiphasic Personality 
Inventory (MMPI), can be the victim of subject manipulation in any kind of 
competitive situation. In noncompetitive settings such instruments can serve 
as excellent research tools, and often equally well as clinical and counseling 
aids, provided they are never used alone but are combined with all other 
available data concerning the subject. This has proven true of both the PIL 
and the SONG. The PIL especially has demonstrated its research value in 
well over one hundred doctoral dissertations, Master's theses and other 
studies. But even together they cannot detect the individual who is motivated 
to appear more motivated to achieve the goals of an alcoholism treatment 
unit than he really is, or the individual who really is motivated to achieve 
these goals but who may perceive no way to do so and therefore may tell 
himself that he doesn't care, that he likes himself in his present condition. 
For these reasons the best all-around selection of good candidates for 
logotherapy in an alcoholism program has proven the combined "gut" 
feelings of the staff who have come to know each patient. Since logotherapy 
is a highly cognitive and directive process, the selectees must have at least 
normal intelligence and be free of more than minimal cerebral damage, 
which may have resulted from alcohol abuse. But formal education has 
proven to have little relationship to success. 
The selected patients meet in open-ended small groups numbering from 
two or three up to ten or twelve at times, five days a week for an hour and 
fifteen minutes each session. The procedure is basically an instructional 
course, which runs for three weeks, during which the material in my new 
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book 3 is presented and explained. Although there is time for class discussion, the course per se avoids eliciting individual psychodynamic material which cannot be handled ade4uately. Patients may ask for private appointments, and they all participate in group dynamic therapy conducted by other therapists. The purpose of the course is to ground the patients in the application of logotherapy, which they can carry out on their own after leaving the program. Only a knowledge of principles and a start in their use can be accomplished in so short a time. 
A FIVE-STEP APPROACH 
I conceive the application of logotherapy in five steps. Before starting them the key role of motivation in overcoming alcoholism is emphasized: we all require a motivating life purpose to enable us to face life's frustrations. Lacking it, we will cop out from meeting unpleasant reality by whatever means are handy. The alcoholic has a built-in habit of escape through this drug. But finding a motivating purpose enables us to go on under Nietzsche's dictum, so often quoted by Frankl, "He who has a why for his life can stand almost any how." 
If motivation is the key to alcoholic recovery, logotherapy can be the key to finding this motivation (again, if one is motivated to be motivated). So the principles of logotherapy are presented; then its application is explained step by step: 
Step 1. Choosing a basic life style or interpretation of the nature of the world and of the human being. From earliest recorded history to modern times two antithetical views have pertained: (I) The mechanistic view, which holds that in spite of the order and regularity of law in nature, there is no purpose or design behind it and no Higher Power or Intelligence which ordained it. (2) The teleological view, which holds that all nature unfolds toward some ultimate aim or goal or end purpose. This includes, but is by no means limited to, those who consider themselves religious. Many institutionally anti-religious people (e.g., many parapsychologists) hold this position. 
Since neither view can be proven or disproven scientifically, most people ignore the issue until some life holocaust makes it important. Then the choice of view determines how the crisis will be faced. The mechanist has only his own inner resources plus those of his professional helpers. On the other hand the teleologist may have these plus the religious help of a theologically conceived Higher Power; at least he has the feeling that because design and not the rotten luck of pure chance is behind the situation, he has some purpose to fulfill in searching for the fit of this situation to that design. 
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Both views require individuals to take responsibility for their own lives, and in the two cases one may do the same thing but for different reasons. The key here is that they have motivation furnished by their life view. Lacking this, they are likely to do nothing constructive, but to cop out from reality through such escapes as alcohol. 
At this point many alcoholism treatment programs introduce the spiritual dimension as the key to recovery. Alcoholics Anonymous is based on this. But while it has the best track record of any single treatment modality, in my experience it "turns off" 20% to 25% of alcoholics. In spite of its emphasis upon individual interpretation of "a Power greater than ourselves," to which its members turn in the second of their twelve steps, the use of such phrases as "God as the individual interprets Him" causes the system to come through as "too religious" in the minds of many alcoholics. Here logotherapy shines, for it introduces this same noetic or "spiritual" dimension without the emotionally loaded terms of religion. There is, however, certainly no conflict between Alcoholics Anonymous and logotherapy; the two can work well together. 
In my empirical judgment about 80% to 90% of alcoholics do believe in a teleological universe, although only about 50% are favorably inclined toward conventional institutional religions. The majority are basically religious infeeling, though many of these are not so on the cognitive level. 
It would be expected that most alcoholics would have religious feelings, for religion represents a life style based on the assumption that help from a Higher Power is at least possible under some circumstances, and alcoholics as a whole have strong dependency needs. In general, so do most people under stress situations. If we don't find the support we need in constructive sources, we will turn to other types of dependency, such as alcohol and other drugs. Some people are emotionally suited to going it alone in these situations; others are not. But many people pick up the attitude that standing alone makes them appear strong and "adult." In my experience it appears that no more than 20% of the general public arc genuinely suited to a purely mechanistic view of life. When those who are not but are trying to act as if they were, meet life crises, they usually can't hack it alone. If they have any tendency to depend on alcohol, this situation will exacerbate it. 
Some years ago a large city psychiatrist was in the hospital as a patient and entered one of my logotherapy groups. When we came to the study of this Step l, he said the reason he had broken down was that he needed emotionally to believe in the teleological view of nature and further to embrace the religious view, but that his mechanistic scientific friends would cause him to get over on their side, and then he would falter between the two views. The anguish of an ambiguous world he could not tolerate (as schizophrenics also cannot). H c escaped the ambiguity through alcohol. The schizophrenic escapes by a break with reality. 
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The issues in this Step I are important to most alcoholics, though they may seek to cover this fact. I attempt to clarify the two opposing points of view, to show why personal choice is important, to present basic evidence on both sides, then to charge the individual to examine his own feelings to determine which view he needs to believe. 
Following that, there is only one remaining task in Step I: to develop faith in that view, even though it cannot be proven scientifically. And this faith is dependent upon one psychological trait: self-confidence. That is what the psychiatrist, mentioned above, lacked. If we believe in ourselves, we can believe in our judgment about nature; we can choose the judgment we need, stick to it and act on it. If we don't, we will intellectually fibrillate, just as the psychiatrist did. This is devastating to life efficiency. 
Therefore. Step 2 in applied logothcrapy is building self-confidence. While there are many approaches to this, I do it by an exercise in autosuggestion. And this is tied to Step 3, stimulating creative thinking. If we are going to find a new meaning and purpose in life, we must first determine the life style which we arc going to follow in doing it; we must then believe we can do it; and we must then exercise our creative abilities in the process. 
To stimulate intuitive creativity in finding new life meanings I use a simple form of meditation, and a technique of projection into ambiguous visual stimuli. In helping subjects to make the meditative technique work, a combination with the method of autosuggestion in building self-confidence is often useful, though the details are beyond the scope of this paper. 
Step 4 is establishing "encounters." those deep interpersonal relationships which are really the core of life meaning. Through encounters we fulfill the "need to be needed," which is the essence of "the will to meaning." Thus Frankl emphasizes that true meaning is always found in reaching beyond ourselves to others. 
Hut to bring ourselves into encounter relationships with other beings we have to do something, even if it is only petting a dog. W c usually confuse the "doing something" with the essence of meaning. Thus we may say, for example, "Being a lawyer gives my life meaning." We overlook that the real meaning comes from the feedback of appreciation, respect and acceptance which comes from whatever we do creatively. 
So the fifth and final step in applied logotherapy as I practice it is finding a task or life activity (a vocation, avocation, or a cause to believe in and work for) which leads to the encounters that establish this meaning. To do so we must utilize all possible assets in the face of whatever liabilities we have. 
Thus I title this step dereflection, Frankl's term for manipulating attention from limitations to usable assets in finding meaning. Actually the entire process of logotherapy is a part of dcreflection. And in the last analysis this process is "spiritual" (in the logotherapeutic rather than the religious sense), because it leads us into the noetic dimension, that vector of life beyond 
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ourselves and in the realm of relationships to "significant others." I work with patients in the process by a series of exercises which cause the individual to explore his life experience for hidden assets that can cancel his liabilities and lead to hitherto unseen meanings. 
COMMITMENT 
The final aspect of applied logotherapy (to which I do not refer as a separate step) is the adoption of commitment in working toward the meanings that have been found by applying the five steps. Without dedication to this achievement the finding of meaning is useless. But if meaning has really been found, commitment will follow as night follows day. So the final scene here is to call this commitment to the attention of the logotherapy group, so they can see that if they don't work to achieve their meanings, the latter are not genuine and they must start again to search. 
What percentage of alcoholic patients selected for logotherapy are helped by it? A lack of adequate follow-up studies in most alcoholism treatment units (because such studies are extremely difficult to do well) prevents accurate evaluation of either logotherapy or other modes of treatment. But many ex-patients come back years later and credit logotherapy with a substantial part of their recovery. On the other hand, other patients recidivate because neither logotherapy nor any other aspect of the treatment program has helped them. We cannot predict before the fact which will be which. But the signs of the times. the Zeitgeist . indicate that the message of logotherapy is only beginning its ascension, and that success will grow as logotherapists grow in applying it. 
JAMES C. CRUMBA UGH, Ph.D has recently retired as clinical psychologist at the Veterans Administration Medical Center, Biloxi, Mississippi, and now is in private praclice as a counselor. He is Regional Director of Logotherapy Chapters for the South. The basic approach to application of logotherapy to problem drinkers offered in this article is presented more fullr in his hook reviewed in this issue. 3 
REFERENCES 
I. Crumbaugh, James C. "The Seeking of N oetic Goals Test." Psychosometric Affiliates, P.O. Box 3167. Munster, Indiana 46321. 1977. 
2. _____ and Leonard ·1. Maholick. "The Purpose in Life lest." Psychosomctric Affiliates. P.O. Box 3167. Munster. Indiana 46321, 1969, 
3. _____, W.M. Wood. and W.C. Wood. Loiotherapr: /\'cw Help j,,r Prohlem Drinker;. Chicago, Nelson-Hall. 1980. 
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International Forum f01 Logntherap~ Vol. 4. ;s;o. I. Spring Summer 19XI 
The Executive in an Age of Alienation 
Frank E. Humberger 

The executive experiences alienation in three areas: in his home, in his office and within his culture. Alienation is a state of estrangement within the self that is felt, consciously or unconsciously, as a split-level personality. Rather than a sickness, alienation is a dysfunction of the self that evidences itself as impoverishment, boredom, apathy, impotence, vagueness, withdrawal, all of which result in a general sense of douht about self-worth. 
The age of alienation is exemplified by the executive who said, "At work I look at the world and say, 'How great I am,' while my gut is producing ulcers. At home I struggle to be accepted as a person while knowing damn well that my worth lies in my pay check. In the community I am expected to do good, to build the corporate image when I'd much rather be home with my kids." 
Not all executives live a split-level life. Studies show that managers, on the average, like their jobs more than do people lower in the organization.9 However, many executives in their midyears, ages 35 to 60, have confided in me their deep dissatisfaction with their daily routine, the trap they have built for themselves that keeps them working to continue as industrial leaders, loving fathers, and community benefactors. 
Alienation at home is caused by a paradox of executive as leader/ friend. Peers want a leader, family wants a friend. "Coming home" rc4uires leaving the dynamo at the office. Competitive ethics have to give way to cooperative living. Power must give way to love, and scheming to open trust. And these gears must be shifted on the way home! Many executives arc bothered by the 4uestion: ls there any standard or value that can fit both worlds? It's dogeat-dog at work and child's play at home. Which is the real me? 
At work, alienation is caused by the corporate integrity called "win at any cost" as contrasted by the individual honesty which often cringes at using all means for a specific end. The integrity of the leader of the corporation, 
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International Forum for Logotherapy 
which is a profit machine, by function and policy means winning at any cost; personal honesty must sometimes become secondary. The executive's functional integrity that says "win at any cost" may mean to bend the truth at times. ls truth to be found in the traditional conscience of the executive or in the struggle of the corporation? 
Executives fear the organization, loss of their position, financial failure, and the estrangement of their family as they give so much time to work. They fear their organization and family situation, but also the infringements of poorly-management macroeconomics, unmanageable human rights movements, and even "brother" executives of other competitive corporations. 
Alienation within the culture is caused by the paradox of "reality" and "anxiety." The reality lies in the question of loyalty: shall I give loyalty to the dollar, yen, pound, franc; to the small corporation or multinational conglomerates; Republicans, Democrats, or Independents; the me-society or mission society; liberationists or libertarians; chauvinists or androgynists? The anxiety side of this paradox is: can I be the real me in this reality choice? How do I know the real me in an I-It society of such pluralistic choices? Culture is a whirlwind, and the person without a rudder and some standard of how to steer will be "tossed to and fro and carried about with every wind of doctrine, by the cunning of men, by their craftiness in deceitful wiles" (Eph. 4: 14). 
All of us, at one time or another, have experienced the paradoxes of competition/ cooperation, of being lured into winning at any cost, and of being tossed to and fro in the whirlwind we call culture. The questions raised by these paradoxes of alienation include: Who is the real me-at work, at home, and within the culture? How can I know the real me? 
Is there any standard, ethic, value, or meaning that can fit all three areas? 
How can the executive handle the split-level life that has all the ingredients 
for developing a split-level personality'1 What can logotherapy offer the 
executive in an age of alienation? 
SOME FORMS OF ALIENATION 
Many reasons have been advanced as to why we live in an age of growing alienation: the pursuit of pleasure, the search for affluence, the erupting mesociety of narcissism, the explosive age of technology, and the implosive age of a growing lack of affection and intimacy. Sociological, psychological, and philosophical studies deal with these subjects. Korman and Korman 10 point out as sources of executive alienation the organizational-cultural-marital pressures that place a high value on income, power, and success, and the contradictory life demands, such as success versus human values, or work 
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commitment versus family relationships. Bell I claims that our cogmt1vetechnological-stressful culture has generated time, leisure, and affluence that stimulates the me-society, the "everyone for himself' culture. Add to this the Gestaltists' "here and now" emphasis, and we get "I want it all, here and now," the cry of Marin County affluent society, alienating tradition for the sake of moment-by-moment solutions to very complex problems. My own experience in eighteen years of personal industrial counseling of executives has convinced me that technological innovations in the world of work, the liberation movement in the family, and the me-first attitude in culture are the primary causes of alienation in the executive's world. Some answers have to be found before the age of alienation becomes the age of lemmings when in our frustration for some meaning we all run off into the sea. 
Alienation comes in many forms. Borrowing from, and building on, the work of Dorothy Meyer Gaev5 I would name five forms of alienation: (1) Inner-self alienation, (2) Physical alienation, (3) Emotional alienation, ( 4) Cultural alienation, (5) Spiritual (human) alienation. I have added the alienation of the spirit because, as Frankl points out, it is the dimension of the spirit that makes us truly human, and because I have achieved success in counseling executives when I introduced this dimension. 
Frankl stresses the dangers of a direct pursuit of pleasure and power that may result in an existential vacuum. Many pseudo answers sought by executives augment Frankl's assumptions. 
Inner-self alienation: Compulsive busy-ness, overdependence on the bottle, another person, work, or other addictions lack the commitment to self-esteem and to the building of one's total self. 
Physical alienation: Alienated couples spend lifetimes brooding, blaming, or sex-searching pleasure seeking. This lacks the commitment to the truly human dimension. 
Emotional alienation: "Taking a trip," escaping to sex clinics, massage parlors, serial marriages lack commitment to relationships at an involvement level. One executive told me it was foolish to commit oneself to another person because one could be hurt too easily. Suffering is a no-no today, rather, instant emotion is the pursuit. "Three months' relationship is about as much as most of us singles can take today," another advised. 
Cultural alienation: Demands to elect a "better" president, start another business, conform to society through "Let George do it," or develop a new power play in the community are superficial commitments to a life that lacks internal integrity. 
Spiritual alienation: Pseudo causes such as Jim Jones, groupies, phony commitments such as sought by the "poverty enterpreneurs" who drain money for themselves from intended "good cause" recipients, and generally a lack of relatedness to values, symbols, and patterns 4 arc characterized by a lack of commitment to enduring and tested values. 
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GUIDANCE FROM LOGOTHERAPY 
Frankl has been called a moralist in the Kantian sense of advocating a moral order that assures (logical) governance of the world. Frankl is one of the few contemporary philosophers who has a key answer to alienation. We need the assurance of the Logos in this whirlwind socioeconomic and political society. We need the assurance that meaning can be found in work, home, and culture if we decide to give ourselves to that search. In fact, the search for meaning as such will break the hold that alienation is gaining. But the "will to meaning" must be free (as Kant's will of the "noumena," the intelligible realm, must he free) to treat the human being as an end, never as a means only. 
With a freed-up will to meaning, executives can search that vast chasm between what they are and what they long to be-the chasm between being and meaning-to discover, indeed to evolve, the many values that are uniquely theirs. Through this free-will search and value-embracing, moralsconfirming meaning, the being will flower. The logotherapist must not tell the clients what values to embrace and what morals to confirm, but must leave it to each individual to find his or her own. The logotherapist simply asserts that values, meanings, and order exist, that there is a unifying principle in the universe (Logos). The World Order promises a metamorphosis to each free-will person who searches. When the client can sharpen his inner ear to hear the "unheard cry for meaning"3 alienation can be stripped of its powers. This release happens in logotherapy, as I have presented previously_r,,7 
BARRIERS TO MEANING IN THE EXECUTIVE LIFE 
My counseling practice indicates, nearly without exception, that executives are hungry for an ethical posture, amidst their daily contradictory demands. Howard R. Raiffa, professor at the Harvard Business School, defines the new ad hoc ethic of gamesmanship as "teaching budding businessmen to negotiate in the real world. 15 One of his students got the highest grade in his "Competitive Decision Making" course because "I was willing to lie to get a better score. " 15 Robert J. Ringer says that he is replacing "the nice guy myths" by "winning through intimidation."12 Ringer uses the following four cornerstones: The Theory of Relativity ( example: honesty versus integrity); the Theory of Relevance (make every minute earning and receiving income); The Thirty Year Theory (death is real and I have thirty years to "get on with it"); and the Ice Ball Theory (don't take myself too seriously). Even at best, winning through intimidation is an impersonalizing theory, though quite real in the ad hoc world. Michael 
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Frank E. Humberier 
Korda says that it is okay to be greedy, ambitious, to look out for Number One, to have a good time, to be Machiavellian, that honesty is not always the best policy-that it's okay to be a winner and it's always okay to be rich.8 
One barrier to the executive's "free search" for meaning is the new ad hoc ethic the future is now, take it one way or another. Another barrier is the organization's demand to win through team work. Not only are the new business students encouraged to lie, they are taught to win as team members or leaders. A paradoxical ethic develops: cheat if necessary but be respected by your team members; scheme to make a profit while relating as human beings. Stay alive in your job while training others to replace you. One executive has the reputation for being "a very likeable guy who fires people as easily as buying a cup of coffee." These paradoxes exist: succeed through teamwork but don't get trapped by the team spirit; be independent as a person but dependent on others for your performance; be successful but don't intimidate the less successful while you help them succeed; take pride in yourself but participate in your team. 
In the executive's home there also is likely to be a confusion of ethics. Some spouses work in the home, some fulltime outside and fulltime in the home, some flex-time outside and fulltime in the home. One thing is sure, says Seidenberg: 13 the corporate wife of the Sixties is a corporate casualty since she no longer serves the corporation through the mate. She not only does not serve the corporation, she has lost the traditional concern for her husband's work ethic. One wife, secure in her own position, when she learned of her husband's being fired, asked: "When are you going to keep a job longer than ten years?" Maryanne Vandervelde 14 discovered in a survey of 1,000 wives of chief executive officers of the Fortune 500 companies that, though most believe they are helpmates, they are also "to do their own thing"-as a positive self-centeredness. Some spouses, doing their own thing, are sex-searching, work-searching, cause-searching, and psychesearching. We are in an era of couple-flex, with inadequate ethics in flextime, boredom in fulltime, alienation of children most of the time, with resultant personal failure felt by the father/ husband, mother/ wife. Two executive families counseled because of "unexplained child behavior" discovered that they had lost sight of the purpose of family life: to train children in values. Schools train the brain, friends train the affective dimension, but only parents can train values, ethic and morals. 
LOGOTHERAPY AND ALIENATION 
I know of no other therapy espousing values and morals, ethics and order in the same fashion as Frankl's logotherapy. He stands as the "existential 
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hero," the freedom-responsibleness giant, when compared to the here-andnow therapies, the feeling therapies, the pleasure-principle or powerprinciple therapies. His is a healing therapy based on the assurance of a meaningful universe, a freely searching will, and an accepting cultural milieu. Elsewhere 6 I have posited that logotherapy is effective with those who have a belief in world-orderliness, have a sense of idealism, believe in both the "now" and the "then," have a sense of responsibility to their world, a self-honesty conscience, some purpose in life, and the capacity for selftranscendencc. The executive with even some of these qualities will be able to break the barriers of the ad hoc, paradoxical, and confused ethics. The honesty-integrity issue at work becomes the honesty-honesty ethics. The leader-friend paradox at home becomes a first-priority ethics. And the future-is-now ethic of our culture becomes a past-present-future dynamic or orderliness. The national state of anomy, of valuelessness, can change to a state that enables keeping human life human. Peter Drucker speaks of doing the right job before worrying about doing the job right.2 Logotherapy enables the executive to do just this in regard to ethics: put commitment to human values first before worrying about winning at the market place, being "right" at home, or "looking good" in the community. 
To do "the right job" the executive needs to be led through the four steps of logotherapy as outlined by Lukas. 11 He first has to be led to gain a distance from his symptoms, not to identify with them. He may have failed in his job but he is not a failure. He feels alienated but is not destined to be and remain an alienated person. He may feel doubts about his self-worth but he is not a worthless person. The second step is a modification of attitudes. The client is led to ask a different question about the unhappy situation -not "why did it happen to me?" but "what can I do now?" Was there a meaning hidden in the apparently meaningless, perhaps unjust, situation? Can I find a meaningful attitude toward a situation which seems meaningless? One executive, diagnosed as "depressed" by his physician, was the victim of an anxiety neurosis because he had just sold his business. He was experiencing a terrific sense of self-loss because he identified with his 18-year-old business. When we looked together at his life as an opportunity in which he could take charge as he had taken charge of his business during those 18 years, he began realizing his great potential. He experienced a change of attitudes, no longer overwhelmed by circumstances. He stopped the tranquilizers for "depression" and within two weeks was his old self again, his meaning restored. His grief over losing his business became translated into gaining himself, through a self-transcending look rather than an introspective look. A marketing vice president with years of brokenness in family living has been led to sort out his values in the world of work and world of family. Not "what do I want to do?" but "what is worthwhile?" is now on his lips in 
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Frank E Humherier 
counseling. An "under the table ethics" vice president, when fired for malcommunication among his peers, recognized through the counseling that there was a deeper meaning to his firing. He decided to "go straight" and pay up past debts, mortgaging his home to do it. Many cases pass through the logotherapist's office wherein the firing of the client, that "transcendent shock," brought the executive to his knees. Firing can be an important purification process in logotherapy. 
When a change of attitudes is accomplished and meaning is glimpsed behind apparent meaninglessness, injustice, and arbitrariness, the third step is accomplished: the symptom disappears or becomes at least bearable because a meaning is glimpsed behind it. This brings such a relief that the client is now ready to go, with the help of the logotherapist, on a search for new directions. values, and meanings. This new commitment, this taking charge of one's own life direction is vital in the logotherapeutic process. I will never forget the moment in Vienna, in the Spring of 1965, when Frankl walked into his students' morning session and announced that he had discovered a formula for understanding one's values. "When we choose the same meaning several times then that meaning becomes a value to us," he said. It immediately made sense to me. We discover meanings as life's events pass by and these become valuable, worthwhile, building our self-esteem. Much of my logotherapy consists in building self-esteem. Now, if we turn around the formula and note that certain values build self-esteem, then we are assured to experience meaning after meaning when we respond to life according to our own value direction. How exciting to open ourselves to the possibility of ever-recurring meaningful events just by taking charge and following our self-esteem-building values. 
BUILDING SELF-ESTEEM 
Commitment to an esteem-building value direction is imperative in logothcrapy. I have discovered that alienation to the inner self is prevalent in executives with a lack of commitment to develop self-esteem, as in the case of the executive who sold his business and, in the grieving, could not raise his sights. Another executive, a 40-year-old vice-president of marketing, when fired, became morose, brooding over his inability to communicate with his past boss, which in turn caused his wife to lose faith in him, which in turn drove him more deeply into a panic regarding his abilities. The counselor asked him: "If you had your choice at this moment, given all your accomplishments over the years, what would you like most to do in the next career?" He responded that he had always wanted to have his own ad agency in order to give himself the opportunities for creativity never given him by 
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International Forum for Logothcrapy 
any of his previous bosses. Over the next few weeks as he pondered this commitment he grew in self-esteem, became positive with his wife in spite of her temporary disbelief in him, and after some market research coupled with further self-evaluation, established a creative never-thought-of idea in television production. 
Commitment to building self-esteem is effective in evolving one's creative self. Commitment to the dimension of the spirit is an even more vital avenue to meaning and thus to breaking the grip of alienation. The logotherapist has to steer the client away from pseudo answers to alienation, including sex-searching, liberationism, or libertarianism. A 37-year-old marketing assistant, a radically feminist, cause-oriented woman, met a divorced man she wanted to marry, and found herself in a situation of value conflict. He wanted family, and she wanted freedom from involvement, yet she was committed to marry him because the values she had learned as a child seemed to tell her that she should "go back home," as she put it. But she was also committed to rebelling against that family ethic "which never worked." Over the past twenty years she had been sexually involved with some 25 different men. Her conflict arose from how to bridge the gap from minimal involvement to optimal marriage involvement, from running from suffering to confronting herself empathically? Frankl's concept to the truly human dimension spoke to both her past training and her present situation. By applying "the defiant power of the human spirit" she was able to break behavior patterns, risk her total self. accept her inabilities, transfer her physical commitments to a spiritual commitment, and to want children where previously she had had two abortions, and to risk a human commitment where previously she had run from any in-depth involvement. 
Commitment to self-esteem building is one answer to the alienation of the 
inner self. Commitment to the spiritual dimension is one answer to the 
alienation of the physical self. Commitment to risking interdependence with 
another person is one answer to the emotional alienation. Self
transcendence also plays a part in relieving cultural alienation. As Bell 
states, it's thinkers who cause our me-society.' Thinkers who are nothing but 
thinkers o peratc as categorized selves. N onalienated persons operate from 
the exclusively human dimension of the spirit as the overriding "umbrella." 
All actions are checked by this dimension that includes a self-transcending 
caring for others. The dimension of the human spirit is often apprehended in 
logotherapy by suggesting that the client check goals, economic priorities, 
and personal values. 
Mr. T, a former purchasing agent, was fired at the age of 55 because of 
"incompetence" after twenty years on the job yet he had above-average 
performance appraisals. When challenged to identify his values, he checked 
in with his traditional value of helping people, and particularly helping older 
42 
Frank E. Humberger 
people. His mother had taught him that older people needed the energy of the younger generation (perhaps to persuade her son to be more helpful around the house) and it was this value that now gave him sustenance in choosing to set up a small fixit shop to help little old ladies of his town -at half fee! He had always been competent with his hands, even though his superiors felt he was incompetent in paper shuffling and corporate relationships. 
Another client, Mr. B, a 34-year-old vice-president of a young and growing electronics firm, when confronted with the same questions about goals and values, chose to divorce and give his life to developing his hightechnology firm, with an aim of becoming president. 
1n both cases, logotherapy enabled a clarification of the commitments, with differing results. Logotherapy cannot be responsible for the choice, only for the opportunity of choosing. The logotherapist remains a stable, responsible reminder that meaning, values, and order exist, the client can risk joining the therapist in that order and search for meanings within his or her value framework, finding assurance that "all is right with the world in spite of crazyville at work," as one client put it. The logotherapist can only present a positive prognosis, not to force it on the client. A positive prognosis, in addition to a basic belief in meaning, values, and order, includes a sense of responsibleness, a sense of idealism, a belief in both the "now" and "then," a self-honesty conscience, some purpose in life, and the capacity for self-transcendence. Mr. T had a positive prognosis, Mr. B did not. 
The alienation of the spirit is the most serious kind because it is the most difficult to reach. Mr. B's commitment was to team-winning at any price, and no amount of confrontation regarding the spiritual dimension could break through that form of alienation. The cry for meaning he heard was to develop his cognitive-technological skills-he was a bright, cognitive person. He sought and found meaning in creative activities and work achievement. The danger here exists that all meaning potentials are concentrated in one narrow area. When this area is blocked-by sickness, old age, retirement, firing-the existential vacuum opens. Here the counselor can use logotherapy preventively, by helping the client broaden the fields of meaning to other creative activities, hobbies, human relationships, a reaching out to others in a pursuit of self-transcendence. It is my understanding that logotherapy clients who prosper most thoroughly are those who balance cognitive, affective, and conative (belief system) facets. 
When logothcrapy clients finally are able to use the resources of their human spirit, they will change from arrogant to "reasonable" within the first few emotions following a firing or divorcing experiences. "It was meant to be" ... "God (or life) is telling me something" are statements rooted in self
43 
International Forum for Logotherapy 
transcendence which lead to a change of attitudes through a search for meaning in a senseless situation. Now the clients are ready for looking for new directions, commitments, goals, and the logothcrapy methods can be applied where useful-the Socratic dialogue, paradoxical intention, and dereflection. 
In summary, logotherapy has a uniqueness in that it requires an awareness of world orderliness, an idealism, a sense of responsibility within the freedom of one's choices, a self-honesty, and a self-transcendent capacity. The awareness of these resources of the spirit provide the beginning of the healing process at home. on the job, or in the midst of cultural alienations. Logotherapy can help us see not only that the existential vacuum can be filled, but that humans can become truly human. 
FRANKE. HUMBERGER, Th.D. is president r~f Executive Services Associates, Bellevue, Washington. 
REFERENCES 
I. Bell. Daniel. The Cultural Cunrradinium oFCapitalism. '.\ew York, Basic Books, 1975. 
2. 
Drucker, Peter. Managingfor Results. New York. Harper & Row. 1964. 

3. 
Frankl. Yiktor E. 7he Unheard Crrfor Meaning. Paperback edition. New York, Touchstone. 1979. 

4. 
Fromm, Erich. E1·capejrom Freedom. '.\ew York, Farrar & Kmehart, 1941. 

5. 
Gae,. Dorothy Meyer. Psiclwlogl' uFLoneliness. Chicago, Adams Press, 1976. 


6. 
Humberger. Frank E. "Practical Logotherapeutic Techni4ues." Uni4uest, 1977, 7, 42 43. 

7. 
-----· "Logothcrapy in Outplacement Counseling." The International Forum for Logotherapy. 1980, 3, 50 53. 

8. 
Korda, Michael. Success' New York. Ballantine Hooks. 1977. 


9. 
Korman. Abraham K. Industrial and Organizational Psrclwlogv. Englewood Cliffs, N .J .. Prentiss-Hall, Inc., 1971. 

10. 
_____ and Rhoda W. Korman. Career Success/ Personal Failu!"P. Englewood Cliffs. :>; ..J .• Prentiss-Hall, Inc., 1980. 


11. Lukas. Elisabeth. "The Four Steps of Logotherapy." Uni4uest. 1977, 7, 24 25. 
12. 
Ringer, Robert J. Looking Out Fur Numher One. New York. Fawcett Great Booh, 1977. 

13. 
Seidenberg, Robert. Marriage Between Equals. Garden City. N .Y ., Anchor Press; Doubleday. I 973. 

14. 
Vandcrvelde. Maryanne. The Changin1; Ufe of" the Corporate Wife. New York. McCox, 1979. 


15. Wall Street Journal. "Teaching Kcality." January 15, 1979. p. 7. 
44 
International Forum for Logotherap)' Vol. 4. 1'0. I. Spring Summer 1981 
Teach er Frustration in the American Public School System 
Bianca Z. Hirsch 

Existential frustration, as defined by logotherapy, is a feeling of futility or a lack of meaning and purpose in life. Such frustration is often the result of a conflict between values and action. This may take the form of conflict between short and long range goals, or between the values a person holds and the demands that are made of him or her in daily life. 
Teachers and other members of the American public school system have honed their skills not simply to earn a living but to make life meaningful for themselves and their students. Values, human relationships, and freedom to think and explore are among the objectives of education. Its intent is not to place shackles on the learner, not even under the guise of conformity, but to open vistas and enlarge the arena of freedom of choice so individuals can grow and develop according to their own style of life with as much creativity and spontaneity as they possess. Those working in public education cannot reach these goals when their working conditions impede them. 
CAUSES OF FRUSTRATION 
Existential frustration in schools may be the result of a depersonalizing process similar to that in industry where mass production reduces the individual's sense of uniqueness, when the work demands uniformity of output. when efficiency is the highest value, and the workers are removed from the end product. The feeling of dignity and self-worth that often accompanies a job well done is lost when workers cannot envision the fruit of their labor and are unable to identify in a meaningful way with the end product. Monotony, resulting from repetitive tasks, further reinforces the feeling of meaninglessness and frustration. 
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International Forum for Logotherapy 
These causes of existential frustration are also present in many phases of the American public school system: a reduction of the individual's sense of uniqueness, an emphasis on efficiency, a confusion about the end product (education), and monotony. 
Alienation may still take another form. When a job has too many demands, a great deal of pressure, and a multitude of goals and objectives, the teacher, school counselor. and other staff members may also become alienated and unable to make appropriate choices because of intrinsic conflicts between their personal values and the actions expected of them. Here, the frustration is caused not by depersonalization or reduced opportunities to bring uniqueness to a situation, hut by a lack of opportunity to do a job well, establish priorities, or provide input. Rather than a result of monotony, existential frustration is caused by a multiplicity of purposes and demands. 
For instance, in public schools, existential frustration can be caused: 
1.) When the teacher has too many students and cannot find time to devote to the needs of individual students. 
2.) When the law requires the identification of handicapped students with documentation of evidence but the classes arc large and no time is provided for the documentation of such handicapping conditions. 
3.) When laws mandate free public education of handicapped students between the ages of 3 and 21, yet insufficient funds are provided for establishing classes for these age groups. 
4.) When laws demand "mainstreaming" handicapped students, yet demand that attention is paid to the handicapping condition, especially when the classes are large. 
5.) When the Serrano Priest decision demands that all children in California have the right to equal financial support for education, regardless of where they live within the state. Consequently, wealthier districts arc obligated to share their wealth with poorer school districts, in order to equalize per-capita expenditure. This law does not recognize the fact that education in inner cities or in areas with large immigrant population, is much more expensive. 
These are some examples in public education that create conflicts between values and action, and with which workers in public schools have to cope and which make them feel alienated from their jobs. 
THE IMPACT OF LOGOTHERAPY 
Logotherapy can help because it stresses that we are not helpless victims of our physical limitations, or instinctual drives, or our environment. 
46 
Bianca Z. Hirsch 
Education, as one of its goals, has the responsibility to pass values and traditions from generation to generation. This cannot be done in a situation where values are taught but not lived. Those who work in education must create an atmosphere in which others can grow. Teachers must be helped to recognize their own values, concerns, and feelings, and respect those of others so they can operate within a framework of understanding, free to explore but not exploited. "We are a measure of all things. We are what we love and what we move others to love."* 
Logotherapy encourages educators to become involved in the school situation in such a way that their involvement leads to action, a demonstration of concern and evidence that they are willing and care sufficiently to act in accordance with their beliefs. 
Logotherapy aids teachers to identify the pathways that will enable them to move from existential frustration to purposeful, meaningful action. It will do that by motivating them to invoke the defiant power of the human spirit to take a stand and to make a choice. Logotherapy prevents educators from becoming helpless victims of what appear to be meaningless situations. It prompts them to continue their search for meaning, even under difficult circumstances. 
Hy taking a stand, by changing an attitude toward a task, teachers can overcome anonymity and find meaning in daily taks. One of these tasks is to rise above the difficulties in the "here and now," and consider goals and purposes because the end product, education, is future oriented. The present relationship between student and teacher serves as the foundation of many future interpersonal relationships. The inspiration and enthusiasm that is transmitted in the classroom may launch students on their future careers. Encouragement and support given to students in an hour of failure or despair may spur them to try again and perhaps reach for the stars. 
The logothcrapist cannot "give" meaning to teachers but can help them discover it. 
Whether teachers gain recognition from superiors, peers, or subordinates is not nearly as significant as the attitude they take toward their jobs. They can give students not only factual information, skills, and good work habits, but can inspire them and instill in them a love for learning and a thirst for knowledge. They can share their own accomplishments and help students through trials and tribulations. Teachers have the opportunity to work closely with students to give them the best that is within their personal and professional commitment and training. The meaning teachers find in the teaching situation is individually governed but the attitude they bring to it may serve as an example and have far-reaching effects. 
*II ubert Bonner. class lecture notes. 
47 
International Forum for Logotherapy 
Overwhelmed by rules and regulations, inundated with paper work, pressed by time, teachers often lose sight of the fact that their career choice has been to work with and for the students. If administrative work takes up most of their time, it becomes even more important that the little time they spend with the students is important to both. Helping students see the worthwhileness of getting an education and providing tasks the students can successfully accomplish will make many moments meaningful and help the teachers through other intolerable tasks. 
The defiant power of the human spirit enables teachers to take a stand in all situations-they can defy orders, they can strike, they can challenge decisions, they can submit, or they can get involved and try to work through organizations to effect changes. They can evaluate the alternatives and then use their freedom responsibly to make choices, and it is these choices that will give them freedom and meaning. 
Teachers have an ultimate choice: they can take the "system" as an excuse for leading a meaningless work life, they can find meaningful activities and experiences within the existing system, or they can find meaning by their efforts to make the system more human. 
BlANCA Z. HIRSCH is a school psycholol{ist in the San Francisco school system, working with aphasic students. 
48 
International Forum for Logothcrapy Vol. 4. '.\o. I. Spring Summer 1981 
Life Review and Life Preview 
Mignon Eisenberg 

One of the larger hospitals in Chicago features two copies of Man's Search for Meaning on the bookshelves of every patient's room, next to the standard copy of the bible. Patients derive renewed hope and solace from this classic. It also helps them in the developmental task of the Life Review, 1 prompted by the realization of personal mortality. 
The Chinese expression for the word "crisis" is made up of two characters, one meaning "danger," the other "opportunity." This seeming contradiction is symbolic of the polarities of the human experience, waiting to be consolidated and refined by the maturing individual. Confucianism sees maturation as a perpetual process of self-cultivation, of becoming (more) human, of being on the Way. In a Franklian sense, to "have" the Way, a person must have had threefold meaning orientation: an existential commitment to the future, experiential knowledge, and the wisdom and strength to be a model to others by one's mature attitude. 
The cathartic and humanizing appeal of logotherapy lies in its verification 
of and alertness to the paradoxical. The very foundations of therapy through 
meaning-an unconditional faith in unconditional meaning-were laid 
against a background of utter hopelessness and chaos. The delicate yet 
resilient wings of freedom to find meaning were forged out of the iron fetters 
of oppression and depersonalization of the concentration camps. Frankl's 
profound philosophical and prophetic manifest rose like a phoenix out of 
the ashes of a decadent era. Its rehumanizing credo is a resounding 
affirmation of our uniquely human potential to master our fate and of 
everyone's inalienable option to move from self-centeredness to self-tran
scendence. This definition of humanness provides a compass for ethical 
orientation and maturation, viable guidelines for living and rebirth in times 
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of crumbling values. It restores a sense of human dignity even to those who feel condemned and devastated by guilt and suffering. 
The confrontation and acceptance of our finiteness elevates us from the depth of despair and morbidity and inspires us to apply our liberated energies to meaningful pursuits in the Here and Now. 
Butler" sees the psychotherapeutic function of the Life Review in older people as restorative, counteracting an often occurring fragmentation of the clients' sense of self by encouraging them to reflect on their lives, in order to review, resolve, and reintegrate underlying conflicts and problems. He recommends certain strategies to stimulate the life review: 
Pilgrimages-actual visits to places of one's childhood, youth and young adult life. Correspondence and conversations with family, friends and neighbors who 
are familiar with one's pas·t. Reunions of high school, college classes, family, religious affiliations. Genealogy, family trees, tracing one's roots. Mementos of old times, photos, letters, notebooks. Verbal or written summation of life work, especially useful for childless 
people or persons with little contact with their children. 
The logotherapeutic intergenerational communications group 1 provides an additional tool to enhance the life review. "Each group member is prone to derive maximum benefit from the intensive self-exploration process triggered by the constantly unfolding logodrama as it were, of visualizing oneself in the other two generations." Here, the life review serves as an indispensable part of the (]ogotherapeutic) task of an ever-active process of previewing one's life. 
Logotherapy dialectically broadens the scope of the need to review one's life by injecting the imperative to redirect and restructure one's life wherever possible. This forces the client to engage in a life preview simultaneously with the life review, shifting the emphasis of the process from hyperreflection to dereflection and self-transcendence. The logotherapist intervenes in the open or clandestine self-exploration by engaging the client in a Socratic dialogue, to help him draw on the meaning reservoir of his life. In cases of incurable illness or inconsolable grief, the logotherapeutic approach of medical ministry 5 will foster clients' imagery of self-sacrifice and generativity to comfort them and to help them quench their thirst for meaning, rather than persist in often endless debilitating self-recriminations. 
My clients hear witness to the regenerative impact of logotherapy on 
inventorying their lives, and the discovery of new meanings:4 
It made me feel I was special in having had some insight into this (suffering) at a very young age ... I hope someday to become a 
50 
Mignon Eisenherg 
logotherapist, or at least be in the position to use it in my life dream of being a counselor for parents of terminally and chronically ill children. K .C:., age 38. 
I began examining my life and found a lot wanting. 1 used not to see other people the way I do now, and I feel much more at case and confident about myself. I also know I want to help others. H.R., age 55. 
Time is of the essence, and there is a lot of things people take for granted. Time happens to be one of them. I would like to think that each day of my life I have done something of value. T.D., age 20. 
The fact that I have gone through what I have gone through has made me a real person ... I am more conscious and caring. Sufferings tend to make us better people. G.L., age 25. 
I think I found a sense of worthiness, a new self-worth. I see the way I have lived my life in the past ... If I ever had any doubts, Frankl confirmed to me that my life was not wasted. Ile gave me a sense of pride, of worthiness. AII my efforts used to go in one direction, and I never realized that I could change my attitude. F.N., age 68. 
I decided, as much as I may think of the past, I can't go hack, I have to look ahead ... Frankl gave me a lot of courage, I did and do the best I can. Having lost husband and daughter, I felt very isolated ... But then I realiLed it was up to me to change my own attitude. G.R., age 72. 
I don't talk to my plants, 1 propagate them ... I find it pleasurable to see the first African violet hahy send up the first blossom ... Today is Saturday, music and plants. It seems to me music and healthy plants go well together. Mc too. S.S., age 75. 
MIGNON EISENBERG, Ph.D., teaches psychology and logotherapy at the 
city colleges and at Northeastern Illinois University, Chicago. She is the 
Regional Director of Logotherapy Chapters for the Midwest. 
REFERENCES 
I. Butler, R.N. "The Life Review: An Interpretation of Reminiscence in the Aged." Psychiatry, 1963. 26. 65 76. 
2. 
----~ "Life-Review Therapy." [ieriatrics, 1974, November issue, 165-73. 

3. 
Eisenberg. M. "The Logotherapeutic Intergenerational Communications Group." The International Forum for 1.ogothcrapy, 1979, 2(2). 23 25. 

4. 
-----·The Logotherapeutic Intergenerational Encounter Group: A Phenomenological Approach." Di,,ertation. Southeastern University, :\ew Orleans. 1980. 

5. 
Frankl. V .E. lhe Doctor and the Soul. Paperback edition. New York. Vintage Boob, 1977. 


51 
International Forum for Lognthcrapy Vol. 4. !\ o. I. Spring Summer I9X I 
Application of Paradoxical Intention by 
Other Schools of Therapy 
L. Michael Ascher 
The basic ideas of paradoxical intention, which Frankl developed before the war and reported first in 1939.0 are being incorporated by other schools of psychotherapy and by therapists of a wide variety of orientations. often without the use of the term Frankl coined for his therapeutic technique. 
An example comes from the work of Milton Erickson whose therapeutic strategies have been described extensively by Haley. 111 Although Erickson is primarily known as a hypnothcrapist,5,s Haley indicates that Erickson's techniques are also useful as strategics in interpersonal contexts not specifically noted as hypnotic.9 Haley himself employs these techniques in family therapy. He suggests that an important component both of hypnosis and of psychotherapy in general is the struggle between the hypnotist-therapist and the subject-client, to determine how much influence the former will have over the behavior of the latter. 
Haley also suggests that both resistant behavior and symptomatic behavior are similar in many respects,9 Erickson uses a series of strategies called utilization techniques 5 which he employs to neutralize resistant or symptomatic behavior and gain the cooperation of the client in producing therapeutic movement on the desired direction. 
Although his approach to each client is different, Erickson employs a typical pattern which forms the basis of his therapeutic strategies. He never asks the client to change the symptomatic behavior but rather accepts the behavior and may even encourage the client to exhibit the behavior in a more extreme fashion. 4 Haley 9 hypothesizes that this maneuver places the symptomatic behavior under the control of the therapist. When the behavior is under his control, Erickson suggests a shift of the behavior into a more appropriate direction, or orders a modification which makes the behavior unpalatable. 
An example of the former possibility involved a man who presented the 
complaint that he sat alone in his room wasting time most of the day. 
Therefore he had no contact with people and was lonely. Erickson suggested 
that he go to the public library and waste time there. A library atmosphere 
precludes talking or social contact with others. The client became interested 
in a particular area and began to read in it. One day someone in the library 
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L. Michael Ascher 
saw him reading this material and suggested that he join a group of people also interested in this area. He accepted the invitation and began to develop a social life. Thus by suggesting that his client go to the library, Erickson demonstrated that he both accepted and encouraged the symptomatic behavior. He simply required the client to perform the same behavior that he exhibited in his room but in the public library. The client could easily cooperate with this request because it required nothing different of him. However, the slight modification of the client's conventional behavior enabled him to come into contact with others and eventually to establish himself in a social group. 
An example of the latter possibility occurred when a rr;an consulted Erickson regarding a long-standing condition of insomnia. The client reported that he slept two hours each evening at the most. Erickson knew that the client hated housework and that he particularly despised waxing the floor. Erickson indicated to the client that he could be helped if he were willing to sacrifice eight hours of sleep. The client was instructed that on each of the next four evenings he was to prepare for bed at 8 P.M. But instead of going to bed he was to wax the floor until 7 A.M. at which time he was to prepare for work. Since he slept two hours per night, this merely meant a loss of eight hours sleep. The client followed Erickson's instructions for the first three evenings. On the fourth he decided to rest for half an hour before his evening of floor waxing. He awoke at 7 A.M. From that night he no longer had difficulty sleeping. In this instance Erickson again accepted the behavior and communicated this acceptance by encouraging the client to exhibit it in a more extreme form. Thus, instead of only sleeping two hours each evening he was not to sleep at all. In lieu of sleeping, Erickson persuaded the client to do something which he found loathsome and from which he was glad to escape, even if it meant sleeping normally throughout 
the night. 
Another therapeutic context in which paradoxical intention has been 
useful is behavior therapy. 1,7 I have used the technique as a central 
procedure with associated ancillary behavioral techniques to form a com
plete treatment program for such problems as agoraphobia1,2 and sexual 
dysfunction.3 Alternatively, it has been used as a strategy to gain the 
cooperation of the client in the administration of other behavioral tech
niques. 1 I described a case I in which it became necessary to employ both 
methods of paradoxical intention. 
The client, originally presented as having a driving phobia, was deter
mined to be agoraphobic. His basic concern was anxiety while driving, 
which he felt would lead to disastrous physical consequences (e.g., heart 
attack, fainting) and would result finally in his losing control of the car and 
being responsible for an automobile accident. In an effort to maintain 
53 
International Forum for Logotherapy 
control he would drive very slowly, and stop frequently to allow the anxiety to subside. He was a salesman and therefore found it necessary to travel by car most of the day calling on various customers. Because of his discomfort while driving he was forced to use side streets and noticed that he was taking progressively longer each day to complete his itinerary. It was this latter aspect of the problem which brought him into therapy. It seemed that his free time was dwindling, as was the time which he could spend with his family. 
The client was introduced to an exposure program for the treatment of agoraphobia based on paradoxical intcntion. 1-2 For his first assignment it was suggested that he drive as slowly as he wished but that he was not to stop his car before he arrived at his destination. Rather, he was to allow the anxiety to develop and subside. thereby demonstrating that no contingent disastrous consequence would occur. After a number of weeks the client had remained unable to follow these instructions indicating that he was too anxious to comply. At this point the therapist suggested that perhaps the client was correct and was, in fact, too anxious to carry out the assignment. Therefore. the assignment was modified to allow the client to drive as comfortably as possible. 
The client was instructed not to drive while anxious. As soon as he experienced any anxiety he was to pull over to the side, find a legal parking space (his typical procedure had been to "double park"), turn off the engine, and engage in an imaginal anxiety-reducing technique which his therapist had previously taught him. The client was to engage in this imaginal technique for five minutes. He was to undertake the entire procedure each time he experienced anxiety. 
With each additional week, the therapist increased the duration of the imaginal assignment by five minutes. The client complained bitterly throughout this period about the difficulty which he was encountering in attempting to complete his itinerary each day. He had fallen behind in the work that he did around his house and he hardly saw his family. Finally, the therapist suggested that perhaps the car itself was anxiety-provoking. He therefore suggested that the client not only park his car each time he felt anxious, but that he leave and go to a point from which he could not see the car. Then he was to engage in the imaginal procedure for twenty minutes. 
The client indicated that he could not possibly do this and that there must 
be a quicker way to become more comfortable while driving. He spontane
ously suggested that he return to the original program. The therapist 
advised against this, saying that the procedure might engender too much 
anxiety and the client would risk returning to his original level of discom
fort. Apparently, the client was willing to take the chance because on the 
next session he reported that he had attempted to follow the original 
54 
L. Michael Ascher 
program and was successful in the initial stage. From that point he made rapid progress toward driving without anxiety. Thus. in a behavioral context, the therapist attempted to administer a treatment program based on paradoxical intention. The initial failure can be partially attributed to a lack of cooperation on the part of the client. Employing another paradoxical intention strategy elicited the necessary cooperation enabling the client to obtain benefit from the original program. 
L MICHAEL ASCHER, Ph.D., is associate professor, Department of Psychiatry, Temple University, Philadelphia, and a psychologist in private practice. 
REFERENCES 
I. Ascher. L.M. "Paradoxical Intention," in Handhook ol Behavioral /111erventions. A. Goldstein and E. Foa. eds. New York, John Wiley, l9X0. 
2. 
_____ "The Use of Paradoxical Intention to Enhance Self-Help Exposure Programs for Agoraphohics." linpuhlishcd manuscript. Temple Uni,ersity. 

3. 
_____ and R.E. Clifford. "l:lchavioral Considerations in the Treatment of Sexual Dysfunction," in Progress in Behavior 1'vlodijicatio11. M. Hensen. R.M. Eisler. and P.M. Miller. eds. Ne,; York. Academic Press, vol. 3, 1976. 

4. 
Erickson. M.H. "Further Clinical Techniques of Hypnosis: l.ltili1ation Techniques." American Journal of Clinical Hypnosis. 1959, 2, 3 21. 


5. _____, E.L. Rossi. and S.l. Rossi. Hipnoric Realities: lhe lnducrion of Clinical H_ipnosi.1 and the Jndirecl Forms ol Suggestion. Ncw York, Irving Publishers, HalstedWiley Press. 1976. 
6. 
Frankl. V.E. "Zur medikamentosen Unterstlitrnng der Psychothcrapic hci Ncurosen." Schwei1er Archiv fUr '.\' eurologie und Psychiatrie. 1939, 42. 26 31. 

7. 
_____ "Paradoxical Intention and Dereflcction." Psychotherapy: Theory, Research, and Practice. I 975, 12. 226-37. 


8. Haley, J. Advanced Techniques of Hrpnosis and lhPrapr. New York, Grune and Stratton, 1967. 
9. ______ "Control in Brief Therapy." Archives ofCicneral Psychiatry, 1962, 4. 53 67. 
10. _____ Uncommon Therap_i·: The Psychiatric Techniques of Milton H. Erickson, 
M.D. New York, c'Jorton Press. 1973. 
55 
International Forum for Logotherapy Vol. 4. :\o I, Spring ~urnmer 1981 
Letter to an Unknown Lady 
Elisabeth Lukas 
My dear unknown lady: 
Dr. Fabry wrote me that you are convinced you must emotionally work through your childhood traumas in order to overcome them eventually. He asked me for my opinion because I have many patients who present that problem. Allow me to direct these lines to you and be assured that I am motivated only by my wish to help you. 
Undoubtedly your childhood contained suffering and injustice which had consequences in your later life. We tend to assume that these must be negative consequences, and so a course is set on a definite thinking pattern. Childhood sufferings which we could neither understand nor bear as a child are assumed to continue into adulthoodhood where they cause continuing disturbances. And we conclude that as adults, now better e4uipped to deal with them, we must work over these sufferings so they finally can be left behind. 
But the basic assumption of this thinking pattern contradicts some easily observable laws of nature. In reality, children are extraordinarily tough and egocentric. They quickly accept, for instance, the death of a relative; they adjust to new surroundings and situations faster than their parents; and they can survive emergency situations without problems. All this bears an enormous biological meaning because nature wants children to survive if at all possible, and has armed them with a physical and psychological protective shell-the proverbial "guardian angel." Children can survive a fall that would have broken bones in an adult; they can calmly tear off legs of frogs, which would turn a grown-up's stomach; they can play with building blocks next to the deathbed of a beloved grandmother when grown-ups can only weep. Of course, the strength of children is not unlimited. But the fact remains that children can bear suffering more easily than adults. 
The question you raised presents two alternatives: either your childhood sufferings were to a great extent overcome by you as a child and afterwards were "forgotten" as a further protection provided by nature; or they were so severe that you could not overcome them totally in childhood and you can overcome them even less as an adult. 
()/91-3379/8// /J00-0056$0(). 95 56 /9RI Human .).('ien('es Press 
Elisabeth Lukas 
Let's look at these alternatives: 
You overcame andfurgul your sufferin?,s: 
The phenomenon of "forgetting" is an arrangement by nature that is extremely meaningful and carefully measured out. It reduces the quantity of things we remember so our mind is less cluttered. More importantly, it reduces the memory of hurtful things which cannot be changed and would only be a superfluous burden. Of a deceased person we remember mostly the good things; of a past period, such as school time, we remember the good times we had occasionally. The ability to forget is an essential contribution of nature to the establishment of emotional stability. You can observe this with people who lived through a war. Without the helpful distortion of past memories in the form of biological forgetting, no man would be able to live a normal life after he had been at the front for years, killed other people, been surrounded by corpses, and faced repeatedly his own death. Forgetting is a gift of nature, while the concept of repression is a human hypothesis to signify danger signals. But, my dear unknown lady, to signify danger signals belongs among the favorite games of psychologists filling their consulting rooms. In reality, we can forget only because the danger no longer exists. The terror of war can only be forgotten in peace, and the disagreeable qualities of people only after they are dead. Forgetting means something is finished, in reality as well as in thinking and emotions. It means that the biological danger no longer exists for us, and thus our mind is freed for current activities. 
Nature discourages us from dwelling on past events that can no longer be changed. It secs no biological advantage in remembering, and thus blots out the event by a healthy forgetting. In terms of natural law this means: what is overcome can be forgotten, and what is forgotten has been overcome. In case of doubt I would rather believe nature than the psychologists. 
You have, as a child, not overcome a suffering, and thus not forgotten it: 
Undeniably, some suffering we can never fully forget. It was too powerful to be covered by the protective mantle of forgetting. This is true of suffering experienced in childhood or as adults. We have to accept these blows of fate, and they do leave their indelible mark. What makes them so unforgettable is the recurring question of why "it" had to happen to us. They are kept alive in our memory long after the suffering itself has ceased by our conviction that we did not deserve the suffering. How can a Jew forget his years of torture in concentration camps without ever having done anything to deserve it? How can a mother ever forget a fatal accident of her child when she had loved and cared for it, only to be so cruelly punished? Here the unforgotten suffering is suffering not overcome--the thorn is buried deep in the wound, not allowing it to heal. 
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Dear unknown lady, let forgotten events rest in the past, as nature intended it, and sort out your memories into those that are beautiful and happy, and those that are painful and unforgotten. The latter ones are those that resist a "working through" so they can be completely absorbed. They arc the dark stones in the picture of your personal fate, the indelible dark contours in the mosaic of your life. 
Now reach into the depth of your humanness and draw from it the only strength that can help you overcome your suffering on a human plane~the strength and freedom to change your attitude toward it. Just as surely as you register your suffering, so you also determine how you see it within the totality of your life. You can decide to run amok against it in despair, demanding explanations and accusing, or you can look for solutions through new interpretations. It is not up to us to ask questions as to the whys and what fors of our sufferings: it is up to us to answer the questions and challenges of life, which may well include a suffering. How, then, do you answer to the sufferings of your childhood? 
My dear unknown lady, if you have followed me to this point, you will find the answers which will enable you to live with your pain. Many excellent human beings have been forged in the fire of suffering and achieved serenity through a painful process of maturing. The assumption, mentioned before, that suffering is bound to have negative consequences, does not turn out to be valid. Life teaches us a different lesson. It demonstrates by numerous examples that there are good, even heroic answers to suffering, and that the best human beings are often those who have gone through deep pain. 
If I may venture a piece of advice: don't interfere with the basic teachings of nature. Let the forgotten remain forgotten, and say yes to what you remember, to the beautiful as well as the painful memories. Try to find gratitude for the beautiful experiences, and an attitude toward past suffering with which you can live. It does no good to tear the thorn from the wound, but you can change it into a syringe to apply strengthening vitamins if you see your suffering as a test which you are willing to pass. The fight takes place in the here and now, and it enables you to conquer despair, not in the past, but in the present. You must find an attitude toward your past which will guide you toward a meaningful future. Having lived through childhood suffering may even give you a sense of accomplishment because it enabled you to grow and pass a personal test~before yourself and before the higher power that knows the hidden whys, whatever that power is and by whatever name you call it. 
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