Volume 5, Number 2 Fall/Winter 1982 
CONTENTS 
Logotherapy: Prescription for Survival "From the Bitter Came Forth the Sweet" Mignon Eisenberg .......................................... 67 
The Viktor E. Frankl Merit Award Willis C. Finck ............................................. 73 
The Pursuit of Meaning for Youth in the 1980s: Social Stagnancy Derek L. Dean ............................................. 74 
What Logotherapy Can Learn from High School Students Stephen S. Kalmar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 
Logotherapy: A Grief Counseling Process Mary Ann Maniacek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 
The "Terrestrial" Meanings of Life Irvin D. Yalom ............................................. 92 
Logotherapy in U.S. Universities: A Survey Bianca Z. Hirsch and Vera Lieban-Kalmar .....................103 
Dialogo Group Work and Social Change Norman N. Goroff .........................................106 
Transference and Countertransference in Logotherapy George A. Sargent III ....................................... I 15 
Dereflection in Family Therapy with Schizophrenic Clients James E. Lantz ............................................ 119 
'" Institute of Logotherap~ 
Counseling Tactics and Personality Structure 
Elisabeth Lukas 
The basic principles of logotherapy are helpful guidelines for the counselor to find the proper counseling tactics for clients with various personality structures as they come across to the counselor even in the early stages of the counseling. This article discusses ten personality structures frequently encountered by the counselor and suggests a general counseling 
approach for  each.  
Frankl  calls  for individualizing  the  counseling  process from  client  
to  client,  and  for  improvising  it  from  moment  to  moment.  

To individualize the counseling process means to respond to the uniqueness of the client but not at the price of violating basic logothPrapeutic principles. The ten personality "types", mere samples of what the counselor may face, point out two factors to be considered by the counselors: The client's personality structure which emerges during the sessions, and the basic principles of logotherapy. Clients must not be treated in a way that will humiliate, offend, cause pain, or make them insecure, but neither must they be comforted, supported, or made to cooperate by means contrary to the principles of logotherapy. The therapy plan must not be overdemanding, distressing, or unacceptable to the client, even if it contains the best methods; neither must the plan be questionable in its methods, even if the client likes it. 
To improvise does not mean to apply therapy spontaneously at a whim, but to plan carefully according to the clients' personalities and the requirments of their problem. If individualization means meeting the patients on a solid path, then improvisation means building bridges which the clients can safely cross. 
A. Individualizing from Client to Client Counselors know that they must approach clients in different ways even if the problems are the same and the symptoms are similar. 
The first counseling session offers valuable indications for the subsequent counseling procedure. Clearer than in later sessions it reveals the clients' attitudes toward the counselor, what they expect and hope for, 
3 
in what form they look for -and demand -help, and how they see the role of the counselor. The first contact offers the opportunity to appraise the personality structure of the clients, exactly because both "partners" are still strangers. The skillful counselor therefore will focus attention, during the first session, not so much on analyzing the problems presentedwhich in their totality cannot be grasped so quickly anyhow -but rather on preparing the counseling tactics that will be most suitable to the personality structure of the clients. 
IMPRESSIONS OF CLIENT PROPER RESPONSE ON COUNSELOR OF COUNSELOR 
1. The Insecure 
(Expression of client's personality (Expression of counselor's tactics) structure) Such clients say little, are soft-The counselor should not make spoken, incoherent. They cannot the mistake of underestimating express clearly what they want, the client's intelligence because avoid eye contact, may smoke conof their "neurotic" behavior. tinuously or move their hands nervThey can be helped by gently ously. They appear shy, inhibited, guiding them toward topics where unstable as if ready to jump up they feel secure. It is important or leave. They find it difficult to inquire about positive aspects to trust, to feel hopeful. They of their lives and to take them are fixated on their problems yet seriously. The real problems can hardly verbalize them. Often should be touched only marginally they have been "sent" by someone to avoid the danger of hyperelse and found it hard to bring reflection. It is mandatory to themselves to come to the counselor. first gain the trust of the clients, otherwise it is impossible to reduce their difficulties. BASIC PRINCIPLES: By gaining trust in another person the trust in life can be renewed. 
2. The Arrogant The clients know exactly what The counselor must not allow they want, have definite concerns, being put in the role of a "mechand want to "use" the counselor anic" who is doing a repair job, to help them deal with their concerns. or the clients are reduced to They expect the counselor to behave broken-down machines to be fixed. 
4 
to their liking to which they feel Further, it must be made clear entitled because they pay for the to such clients that the rate treatment. If the counselor does of the fees does not determine not comply with their wishes, they the counseling effort -profes-know they can find another one. sional ethics demand that coun-Occasionally this attitude leads selors help regardless of client to some form of blackmail, quick status. Thirdly, and most imporsolutions are expected, failures tantly, the counselor must impress are blamed on the counselor's incom-the clients that the therapy goal petence. Money often is no object. does not entirely depend on 
the clients' wishes. What can be achieved and what should be achieved are two different things: the first depends on what JS technically possible, the second on the existential needs of the clients. 
BASIC PRINCIPLE: The highest criterion of the treatment is its meaning potential. 
3. The Pessimists 
The  client  emphasizes  right  away  The  counselor  must  not  allow  
that  they  expect  little  from  the  himself  to  become  provoked  
counseling.  They  only  came  to  by  this  show of  pessimism  because  
make  sure  they  have  "tried  every it  often  hides  fear  or  immaturity.  
thing,"  but  they  don't  believe  rn  Neither  must  the counselor accept  
any  success  or  even  in  the  possibility  the  pessimism  because  this  will  
that  their  problems  can  be  solved.  fortify  it.  The  clients  have  
That's  why they hardly find  it  worth +o  be  told  quietly  and  factually  
while  to  talk  about  their  problems.  that  it  is  up  to  them  to  change  
They  give  the  impression  of  oeing  their  fate,  and  that  the  counselor  
rather  resigned  than  hostile,  but  can  only  function  as  a  temporary  
make  it  clear  that  they  are  not  crutch  if  the  clients  wish  to  
ready  to  share  any  optimism.  Oc learn  to  walk  on  their  own  legs.  
casionally  they  directly  announce  If  the  clients  do  not  wish  to  
their  lack  of  willingness  to  coop- do  this,  the  crutch  will  be  worth 
erate:  The  counselor  can  go  ahead  less.  It  is  therefore  necessary  

5 
and try but they not much sense in suggestions. BASIC PRINCIPLE: acceptance of outside Only the awareness of self-responsibility makes the help meaningful. 
themselves  see  to  make  these  clients  aware  
any  counseling  of  their  own  responsibility without  
denying  them  the  offer  to  help.  

4. The Flighty 
The clients have serious problems which they pretend to play down, and they refuse to pay too much attention to them. They display an unjustified optimism: everything will come out all right, even if they won't follow the therapeutic 
advice which will be offered. are aware, however, that attitude holds a danger to health and may harm other (as for instance their driving 
They their their people under 
the influence of alcohol) they ought to take their seriously. But they find fortable to talk about to work on themselves, 
and that 
problems it uncomthem and 
and so 
they escape into unrealistic hopes. Illusions blur their awareness of reality which alone could motivate them to act. 
BASIC PRINCIPLE: One can live with ment but not with hopelessness. 
To destroy illusions and bring out negative facts are among the counselor's most disagreeable tasks. It is therefore imperative, in each case, to consider carefully whether such actions are really necessary and, if so, to what extent. Sometimes, however, they are required to prevent more serious damage, as for instance commitment in an institution, separation from another person, or abandonment of educational pursuits. In all these cases, the stating of the reasons for the counseling advice will hurt the clients. The counselor must proceed like a surgeon and make the painful cut but always in hopes of restoring health. Even if the prognosis is poor, the counselor must be guided only by the consideration of what the negative consequences might be if no therapy is provided, never by those that might occur m spite of the therapy. 
disappointment, pain, and abandon
6 
5. The Depressed 
The clients have suffered a severe Every form of abnormally depressloss and cannot get over it. They ive reaction calls for caution, constantly talk about it, weep, and the counselor will do well are in despair. They are not recep-to seek the assistance of a tive to counseling efforts and shut physician. To play down the themselves off from the world loss ("it's not the end of the because they are submerged In world," etc.) is of little help, their pain. Talking about the pain and may be resented by the IS helpful but also compounds the clients who feel themselves despair. Often this situation illust-not understood. For this reason rates the collapse of a "pyramidal it is advisable for the counselor value hierarchy," the tendency to to accept the clients' feelings idolize one value which now has of loss but at the same time been lost. help them search for a meaning 
behind the situation. To accomplish this, the clients must learn to listen. Their continuous laments must be gently but firmly interrupted, and every effort must be made to slowly gain the clients' attention. 
BASIC PRINCIPLE: To relieve pain by talking and weeping is beneficial but ony up to a point. 
6. The Agressive Right from the start the clients The counselor of such ternperreact irritated and emotional, perhaps mental, emotional persons must even choleric. Their voices rise, not wait too long to get on their faces become red, their breath top of the situation, or there goes fast, perspiration shows on will be the risk of a "hysterical their foreheads. They become attack." It is well to point agitated about trifles, and are agout, right from the start, that gressive toward the counselor and a modicum of regard and politeirritated toward others. They get ness 1s required to discuss the hung up on irrelevancies and angrily problem. Clients are i.1vitcd defend their "rights" or points of to sit down comfortably a.,d 
7 
view. Their aggression may be hidden and burst forth only at certain moments of the session, but then out of all proportion. Contradiction incites their emotional behavior, but so also does sensitive understanding. They may accompany their words and gestures with a sudden outburst of tears. 
breathe quietly before they state their case slowly and rationally. If a topic is so laden with emotions for them that a reasonable discussion is impossible, the counselor should not hesitate to break off the discussion of the topic and postpone it for another time. Relaxation 
=Xercises  may  be  offered,  but  
tears  should  not  be  allowed  
to  have any effect.  

BASIC PRINCIPLE: Where a modicum of self-discipline is lacking, the forces of the spirit are powerless. 
7. The "Authority-dependent" 
The clients are indecisive about what they really want, they are looking for help in their decisions from the expert. They fret because they want to do everything right and do not have the courage for spontaneous decisions. In addition, they often show a blind belief in authority: only the expert can tell them what to do. The clients may have gathered pedantically what could weigh for or against a certain decision, and the list 1s presented to the counselor for the pronouncement of wise judgment. Without expressing it in so many words, the clients' behavior in many cases indicates the wish that the counselor take over the decision making -as the truly "competent" 
person. 
The counselor must not presume to be able to always make the right decision, especially not 
on the basis of information. But the counselor, refuse to give 
a handful of neither must on principle, an answer to 
a question. It must be weighed how far the clients can be trusted to reach meaningful decisions 
by themselves,  and  where  they  
need  direction  to prevent  them  
from  getting  into  unfortunate  

situations. not show, to be made goals so essentials 
This weighing must but the clients have aware of some higher they may distinguish 
from 
A strengthening ability to realize tions may make 
nonessentials. of the clients' these distinc
direction-giving 
8 
superfluous. 
BASIC PRINCIPLE: The goal decides the means to reach it. 
8. The Intellectuals The clients seem unnaturally aloof The counselor must be careful and composed, perhaps also un-not to be drawn into a verbal emotional and inwardly rigid. They shadow boxing, without theraanalyze their problems themselves peutic gains. The counseling and carefully interpret their situasession does not serve primarily tion, without revealing any inner to debate about various opinions feelings or concern. One is tempted and discuss theories. The sessions to tag such clients as "typical should aim at a gradual "disintellectuals" who wish the counseling intellectualization" of the clients, for theoretical discussions to show at the expansion of their experioff their minds, perhaps to discuss ential sphere which may stimulate merely for the sake of discussing. them to resonate to their emo-The entire area of the emotions tions. Because there is the is disregarded, even treated with danger of "talking a problem irony, they may i:>e crowded out to death," demonstrations by philosophical or political ideas and practical activities are helpful and explained away by rational to stimulate the clients' "prearguments. Arguments from others reflective" understanding of are hardly accepted. themselves and their values, 
f.i. a shared walk through the woods, a common visit to a hospital, or similar events where impressions are stronger than words. 
BASIC PRINCIPLE: Emotions can be more sensitive than the mind can be sensible. 
9. The Dependent The clients present themselves Confronting such determinism m the best light and blame everyone which the clients tend to corelse as responsible for their pro-roborate with supportive pseudoblems. Sometimes the past or information, the counselor's mistakes by others also serve as task JS to revive the clients' excuses for present difficulties. freedom of will and their defiant 
9 
The  clients  look  to  the  counselor  power  of  the  spirit  which  ap 
for  the  confirmation  that·  they  parently  have  been  blocked.  
are  not  at  fault  and  they  could  To  this  end  the  counselor  must  
not  have  acted  differently  than  strictly  refuse  to  accept  the  
they  did.  They  want  a  sympathetic  arguments  of  the  clients  and  
counselor  who  will  help  them  piece  pronounce  an  unassailable  No.  
together  a  chain  of  outside  causes  Together  with  the  clients'  "guilt"  
that  would  completely  explain  their  the  counselor  also  restores  their  
present  failures.  Advice  that  aims  dignity;  together  with  their  
at  drawing  their  attention  to  their  responsibility  he  reinstates  the  
own  freedom  to  act  is  shot  down  freedom  of  their  spirit.  The  
or  ignored,  and  interpreted  as  "mis initial  shock  of  the  therapeutic  
understanding."  harshness  is  softened  by  the  
aceptance  of  the  clients  '.\S  
human  beings,  gifted  with  reason  
and  the  capacity  for  decisions,  
who may  not  always be understood  
but  are  always  taken  as  genuine.  

BASIC PRINCIPLE: To possess freedom of spirit is to be free from the enslavement by any conditions. 
10. The Lethargic The clients are empty, burned out Whenever such a noogenic diffithey face the counselor with indifculty exists, the counselor must ference, nothing is of interest. be aware that the existential They answer questions with a yes foundations of the clients have or no, nothing means anything to become shaky, and there is them. Hardly a subject can be danger to life, even if it is found that lures them from their only a danger to the life of reserve, everything bores them, their spirit. For this reason passes them by, and all efforts the counselor must carefully by the counselor only bring out investigate the clients' living a yawn. In severe cases there conditions, to find out whether is a danger of suicide. Often the a change in these conditions damage is done by neglect but may possibly revive the impulses also affluence may be responsible: for motivations. Extreme caution the leisure is spent in boredom, is called for. For example, 
10 
there is no motivation to reach to make such clients financially any goal. The chronic condition secure my be harmful because of the clients is absolute listlessness. this would make unnecessary any efforts on their part to actively do something about their situation. It may be helpful to include family members in the counseling process, and with their help find modest shortrange goals which the clients can or must accept. 
BASIC PRINCIPLE: Into the existential vacuum may enter life-threatening forms of sickness. 
B. Improvising from Moment to Moment 
The clients' personality structure influences not only the counselor's proper response to the individual client but also the most effective therapy plan that can be found for specific problems. 
In the first part of this article I have illustrated the proper response of the counselor on hand of a single situation -the initial counseling session. I shall now illustrate for the same ten personality structures how the therapy plan will differ according to the clients' reactions to their problems -this time on hand of a single symptom. To exclude possible complex interrelations with other symptoms and even more complex feedback effects on the total picture of the clients' sickness, I have chosen a simple one-dimensions! symptom -an isolated weakness of concentration. 
REACTION OF CLIENTS THE THERAPY PLAN TO SYMPTOM (Expression of client's personality (Expression of counselor's tactics) structure) 
1. The Insecure Because of their weakness of concenBecause the clients need to tration the clients feel even more gain more confidence in their insecure, they hardly dare to meet interaction with others, the others and have no confidence to first step toward this goal can take on certain tasks. They are ue achieved in the client-counselor withdrawn, speak little and softly, dialogue. Using a mild form their thoughts wander. Because of paradoxical intention the 
11 
of their insecurity they give the impression of being confused, overly shy, sometimes look ridiculous, and may be passed over by others 
or considered not "all the clients become isolated, introverted, 
there." Thus increasingly odd. Some
times they lose contact with their surroundings altogether and avoid all communication with others. 
BASIC PRINCIPLE: Fear brings 
counselor may tell briefly about _ an interesting event and ask the clients not to concentrate on the story so they will have no recollection of it. Asked about it later, the clients presumably will admit to remember some details of the story. Then a switch of roles is suggested: The client tells about an event and the counselor listens. By telling the story, the clients have to concentrate and thus train their capacity of concentration while reducing their anxiety about _their weakness 
to concentrate. 
about that which is feared. 
2. The Arrogant 
The clients are eager to overcome their weakness of concentration because they feel it prevents them from being successful in their profession or in other areas of life. They would like to get hold of a box of "concentration pills" which would solve their problem quickly and once and for all. Because 
such pills do net exist they are 
willing to go through a training 
program, on condition that a speedy 
improvement is guaranteed. They 
are convinced the problem can 
be solved if only the right remedy 
is found, and they are determined 
to succeed in overcoming their 
Because the clients want to 
force acute their a lot sides, 
something there is the danger they will not reach goal even if they spend of money in trying. Bethe counselor may come 
to realize that 
tration"  is  not  
a  goal  as,  for  
achievement  of  

and a feeling 
"better concenas important instance, the 
inner pe,0.ce of fulfillment. 
It may be necessary to explain to the clients that a hectic pursuit of success is counterproductive because success must not be directly pursued but must ensue. In the course of 
12 
malady. Any suggestion that the the counseling the clients should weakness may have physical causes, be helped to see more clearly such as old age, are hardly acknowthe goals for which it would ledged. be meaningful to strengthen their concentration, and to realize hat efforts in a different direction perhaps may be more rewarding. 
BASIC PRINCIPLE: Success and happiness are mere side-effects of a pursuit of a meaningful goal. 
3. The Pessimist 
The  clients  see  the  future  course  As  soon  as  the  clients  go  from  
of  their  lives  as  good  as  determined:  a  negative  prognosis  of  their  
The  weakness  of  concentration  own  symptoms  to  general  pessi 
is  only  the  beginning,  then  other  mistic  observations  on  the  state  
troubles  will  come,  more  failures,  of  the  world,  their  train  of  
and  it  will  all  end  with  a  mental  thought  must  immediately  be  
breakdown  or  other  serious  dif stopped  and  they  must  be  led  
ficulties.  They  always  have  had  back  to  the  essentials  of  their  
bad  luck,  and  it  is  obviously  their  case.  It  makes  little  sense  
fate  to  age,  become  decrepit  and  to  work  on  their  specific  symp 
forgetful  before  their  time  in  tom,  the  weakness  of  concen 
short,  it  won't  be  long,  and  they  tration,  because  even  if  this  
will  not  be  able  to  function  at  symptom  is  improved,  the  clients  
all.  They  don't  believe  they  can  would  find  other  negative  aspects  
be  helped  -in  fact  they  are  sure  of  their  lives  which  will  make  
that  modern  pharmaceuticals  make  them  think  up  other  dark  sce 
people  only  sicker,  and  in  general  narios.  This  type  of  patients  
these  are  hopeless  times  in  which  can  be  greatly  helped  by  a  de 
we  live...  reflection  group  which  inten 
tionally  accentuates  the  positive  
and  prevents  the  participants  
from  wallowing  only  1n  the  nega 
tive  aspects  of  their  Jives.  A  
dereflection  group  will  regen 
erate  their  perception  of  values  
so  they  can  see  and  accept  

also  the  good  and  beautiful  
around  them.  
BASIC  PRINCIPLE:  The  positive  is  in  us,  or  nowhere  at  all.  
4. The Flighty  

The clients have serious difficulties If no physician has been consulted with their concentration which the counselor needs to be sure could be the result of considerable that no organic cause is behind stress or the onset of a sickness. the present difficulties which But they don't want to think about could be treated medically. that and feel they can handle the At the same time it is useful difficulty without outside help. to convince the clients of the But they make serious mistakes desirability of a healthy life in their work or their lives in genstyle -sensible nutrition, relaxeral, with consequences that cannot ation, and exercises. A restful easily be corrected. They may vacation also may prevent a carelessly jaywalk m heavy traffic worsening of the condition. or forget important appointments. After such discussions, a training Their family and friends urge them program focussing on the clients' to seek professional help, and so cor,r.entration may be started, they finally come to see a counselor. aimed at getting the clients 
to balance stress and leisure, 
strain and relaxation. BASIC PRINCIPLE: All three human dimensions are inextricably interrelated and cannot be separated, even in therapy. 
5. The Depressed The clients have experienced an The symptom obviously is the event that for them was extremely result of unavoidable suffering, sad and which they have not worked so the clients' attitude to this through. They probably will never suffering must be placed m be able to forget it. Since that the center of the counseling event, much has changed in their effort: only through a modifilives, most of all they don't see cation of attitudes can the sufmuch meaning m life and what fering become bearable and goes on around them because their the difficulties in concentration thoughts are still focussed on the be overcome. When the clients event and the circumstances that talk about their suffering, at
14 
have Jed up to iL Their difficulties of concentration are closely linked with their attitude -they are the result of their lack of interest in anything not connected with that event, that 1s, anything lying outside the clients' one-sided value tention can be giving attention are saying,thus can begin with sation_ In its selor has the lead the clients 
focussed on their to what they the counseling such a convercourse the counopportunity t, to see the possi
orientation_ 
BASJC PRINCIPLE: 
bilities of finding a meaningful interpretation of their suffering_ Only then the attempt can be made to expand the clients' personal value orientation, and this automatically will lead 
to an intensified concentration on the various value contents contemplated. 
Every suffering has its meaning_ 6_ The Aggressive 
The clients themselves torgetfuL slips their 
are terribly angry at for being confused and Every little thing that minds upsets them, and 
they may vent their anger on other persons who happen to be around. The rage about their little mishdp:, destroys the positive possibilities of their lives and prevents successes which they otherwise may have had_ Sometimes they develop a self-hate which spills over onto their families and makes life miser
able for them_ 
Because the clients, generally speaking, show not enough sense of humor for paradoxical intention it IS better L'J begin with quieting thnn down with simple, calming hrmulations which enable them to regain self-control and distance 
from their the clients techniques to selves, also 
problems. /\fter 
have learned to use get hold of them-by physical rneans, 
such as regular breathing exercises, a suggestive training of the will can be started that shifts the accent from uncontrolled emotion to factual cognition: their thinking is to regain dominance over their feelings. 
15 
On  this  level  the  clients  can  
handle  their  weakness  in  a  much  
better way.  
BASIC  PRINCIPLE:  One  does  not  have  to  take every  nonsense  from  one's  
temperament.  
7.  The "Authority-dependent"  

For some time the clients have observed certain difficulties in grasping and remembering new ideas, and are uncertain what to do. 
They believe that an expert see the full significance of symptoms. Some clients will books on the subject which further confuses them. They to observe themselves and notice a worsening of their ficulties, which sends them to counselor in a panic. They 
will their read only begin soon difthe ask 
the expert to "uncover" the causes of the problem and the "unconscious forces" behind them. 
BASIC PRINCIPLE: Only by encouraging ness be transformed into ego-strength. 
The expert can use the clients' faith m authority by explaining to them the dangerous mechanism of hyperreflection, and by strongly advising them not to observe themselves and to stop reading in the literature. They are told that the anxious recording of the symptoms is counterproductive. On the other hand, a carefully targeted dereflectiona concentration on the clients' surroundings 1s useful in a twofold way: it counters the existing hyperreflection, and strengthens the ability of concentration and restores the selfconfidence of the clients. 
self-transcendence can ego weak
8. The Intellectual 
The clients have their own hypotheses about their problems. They exactly tell the counselor about how the symptoms originated and what their effects are. This is all described m sober and correct terms. In no way do the clients indicate that the symptoms cause them suffering, they wish to discuss the In general, it may be helpful to test how far the clients are capable of any deeper experiences and if so, of what kind. If 
they are of such assumed 
from an cognitive 
found to be incapable experiences, it can be that they are cut off entire dimension by blocks, in the form 
16 
concentration problems on principle of "inhibitions." Instead of and factually, and seek the expert exploring the origins of these opinion to check their own theories inhibitions, the counselor can with those of the counselor. Some-help the clients revive the expertimes they approach their goal iential dimension by motivating obliquely, pretending to have a them to fill their leisure with friend who suffers from these same creative activities that will symptoms and asking how they stimulate their emotional re-best can help that fictitious friend. sponses. Experiences m art They are inclined to see their difand nature, positive meditation, ficulty as a problem of our age and significant encounters may or our society, the result of an set in motion a chain of reactions deteriorating civilization. that will sharpen their capacity 
for concentration, and also stim
ulate the emotional responses 
of the clients. 
BASIC PRINCIPLE: Finding meaning on the level of the spirit is irrev
ocably tied to the capacity for emotional experiences. 
9. The Dependent The clients admit that recently The clients must be challenged they have had trouble concentrating to resistance, not so much but they blame for it the behavior against the stressful environment of other persons, such as loud music but against their own resignation. from the children's room or imposThey have to be made to see sible working conditions that make that they play their part, that concentration impossiblP. They see they are co-responsible for themselves as "poor victims," facing their difficulties, and that an inconsiderate world, with little it 1S they themselves who can chance to be masters of their fate bring about a change. In the and influence their lives. Questions course of the counseling sessions as to whether they have to stand it will probably turn out that for the noise of their children or the environment is less to whether they have ever thought blame than they have thought, of changing their working place and their resistance can then only draws a resigned shaking of be converted into a healthy their heads. defiant power of their spirit 
17 
against  their  own  symptoms.  
Thus,  the  difficulty  is  mitigated  
through  an  increasing  strength 
ening  of  the  clients'  capacity  
for  self-distancing.  
BASIC  PRINCIPLE:  Only  a  healthy  resistance  can  overcome  an  unhealthy  
dependence.  
10. The Lethargic  

The clients hardly talk about their symptoms, they sit there demonstrating them by being unattentive, confused, unconcentrated. The words of the counselor pass them b there is no reaction, and their responses are scarce and off the subject. Their apathy stops ever-thing, concrete suggestions lead nowhere. There is no motivation to do anything about their concentration. Sometimes a trace of defiance shows in form of a secret 
smile about the counselor's efforts which are so utterly uninterestingwhat is the use of it all? To concentrate well seems just as pointless as to concentrate badly. 
Despite the clients' lethargy there certainly must be something that is important to them, something to which they are not completely indifferent. Perhaps it is a way of life that feels comfortable, a certain place they like, or the contact with a person who means something to them. That would be at least a starting point to get the clients to move from a readiness to make a minimum 
effort to a desired contact: effort to 
to come In case without worth an 
the attainment of condition of human they must make an concentrate rn order closer to their goal. they are completely anything that seems effort, a sudden change 
of environment and the challenge of a new task may bring about an inner change, for instance, their being sent to help in a disaster area. 
BASIC PRINCIPLE: If you consider your life without meaning, you do not see the tasks life has in store for you. 
Elisabeth Lukas, Ph.D., is head of a counseling center in Munich, Germany, and author of several books on logotherapy, not yet translated into English. 
A Child, Paradoxical Intention, and Consciousness 
James D. Yoder 
The phenomenon ofhuman experience again verified for me the nature ofthe noos, the reflective conscious center that is behind all drives, urges, feelings and habits. Frankl writes," Authentic existence is present where a self is deciding for himself, but not where an id is driving him. "2 
Can a little child detach itself from habit? Is the full conscious decisionmaking capacity for choice only an attribute of an adult? How much "noetic power" resides within a small child? It may be that in some ways a small child is closer to the noetic center, experiences less impedimentia, and is therefore, when given assistance from another caring human being, able to see quickly and clearly. Frankl states: "What is called paradoxical intention is a logotherapeutic technique designed to make use of the human capacity for noo-psychic detachment. "1 
Seven-year-old Stephanie was referred to me by an orthodontist who had explained to Stephanie that she needed to stop her thumb-sucking if orthodontal work would be completely successful. 
Stephanie's personal history revealed that she had sucked her thumb since birth. "I had my thumb in my mouth when they brought me to my mother," Stephanie told me. For the last two years, Stephanie did not suck her thumb in school, but she did, off and on, frequently at home and every night in bed. 
Upon our first session, I met with Stephanie and her mother together, next with Stephanie alone, then for a brief review with them together. All in all the complete therapy consisted of three sessions and one follow-up session. 
Stephanie lived in an upper-middle-class home where middle-class values such as success, cleanliness, order, and appearance were emphasized. They lived in a large country house and drove to my office, a distance of sixty miles one way. 
In my initial interview, I discovered no maladjustments or inappropriate coping styles. Stephanie was obviously alert, above average in intelligence, and motivated to make some changes in her life. I did detect some anxiousness with her when her mother joined our session. 
After reviewing her health and developmental history, I evaluated her motivation, level ofawareness and need for change. Stephanie clearly pointed out that she wanted to stop her thumb-sucking but just "could not." We reviewed together what her orthodontist, Dr. Mills, had said to her. "He said I needed to stop, that it was making my teeth stick out," clarified Stephanie. 
19 
As Stephanie and I related to one another alone, her warmth and vitality were evident. Would she be able to understand the many "faces" or parts of us as human beings, phenomenologically? I said to her: "There's one part of you that says I need to stop this thumb-sucking. It's ruining my teeth and besides, I really don't need it any more. Then there is the other side of you which says, Oh no! I can't give up my thumb, it comforts me and makes me feel warm like an old friend." 
With bright eyes, listening intently, Stephanie leaned forward and said, "Yes, and I don't know which part is going to win." Thus, she gave evidence of her internal struggle with a comforting habit. Could she detach herself from habit? 
"But you do want to change, don't you? You said you want to stop sucking your thumb. We'll make a plan to help you," I said encouragingly. Stephanie's mother, not even knowing about paradoxical intention, had written on the intake form, "Stephanie is willing to take the treatment." 
Prior to the session with this client, I had re-read Jepsen's article3 on the application of logotherapy in dentistry with special emphasis upon paradoxical intention as an effective method to bring about change with a motivated client. 
Together Stephanie and I drew a calendar on 8½ x 11 inch paper. Two months were displayed with all their days, June and July. We were at the time, on Saturday, June 5. 
"Now look at all these days ahead of us, Stephanie." I slowly traced my finger over the calendar. "All of these days for sucking your thumb as much as you need to." Then I explained that we would set up thumb-sucking practice times. 
Stephanie looked at the days ahead, smiling. 
"Now, pick a time on our calendar when you believe you will no longer need your thumb," I instructed her. Demonstrating her strong motivation, Stephanie immediately picked the very next Tuesday, giving herself only three days. I experienced this as I) strong motivation for change and 2) willingness to do her "therapy" just right to please me. 
Explaining to her that I believed she might need a bit more time with her thumb before she no longer needed it and could we trace over the days again and give herself a little more time so she "wouldn't feel rushed," Stephanie's finger stopped on June 26th, giving her exactly a time span of four weeks. 
Jepsen writes: "When the youngster decides that his thumb-sucking practice is 
silly, and unnecessary, he decides to quit the habit. Treatment lasts from two to 
eight sessions" (p. 126). 
Stephanie was given instructions to practice her thumb-sucking with vigor for 
twelve minutes a day for the first week. Practice sessions were to be in the same 
place and at the same time daily. 
At the next appointment, the second session a week later, again I spent some 
time alone with Stephanie's mother, then the remainder of the time with 
Stephanie, plus a summary period with them together. Her mother was con
cerned and was doubtful if her daughter could break her habit. I supported her 
in this doubt-but encouraged her to remember I) Stephanie's commitment to 
stop on July 26, 2) her dedication to her practice sessions, which she religiously 
kept, and 3) the power of the client-counselor relationship that was established. 
20 
At this time I also gave instructions that Stephanie's father should arrange to take Stephanie out to dinner when she successfully completed her mission. New practice time was reduced to nine minutes. 
A week later, third session, Stephanie's mother was a bit anxious and discouraged. She had not been as fully supportive as I had desired. She had sent her daughter to her grandmother's house during the week to attend Bible School for three days. I was told that Stephanie, during those three days hadn't kept up her practice sessions. This was said with apology. Stephanie's commitment to action, growth and change, plus the strength of her noetic powers, however, triumphed. When I saw her alone, Stephanie told me she had "doubled up her sessions to make the time up." I sensed we were on the road to victory. 
At this third session, I again carefully reviewed for both Stephanie and her mother the necessity for the regular practice sessions. They should be held the same time each day. I instructed Stephanie to "really work on her thumb five minutes each practice session. Do not just let your thumb lie in your mouth." As they departed, instructions were given that they should call me if Stephanie decided she no longer needed her thumb before our fourth scheduled session. 
Within three days I received a long-distance call from Stephanie. She happily informed me she had made the decision and no longer needed her thumb. For the first time in her life she had slept an entire night without sucking her thumb. She had stopped on Sunday and called me on Tuesday to report the good news. 
One final meeting was held. Stephanie reviewed her "evening out" with her father where she celebrated the achievement by eating shrimp. 
Her mother was joyful and said that "Stephanie has changed. She has matured." 
This case clearly points out the power of reflective consciousness in decision making, the triumph ofthe noetic. It also points out the matter ofuniqueness of each client. Frankl I states this relationship between two persons seems to be the most significant aspect of the psychotherapeutic process, a more important factor than any method or technique. Paradoxical intention as a technique was combined with human closeness and scientific detachment. 
One cannot conclude that something important did not happen in the three 
counseling sessions and the paradoxical intention practice sessions. "... para
doxical intention is not as superficial as it may first appear to be. Something is 
certainly happening at a deeper level whenever it is applied. "1 
Frankl labels this "something" as a "restoration of basic trust in Being ... 
What transpires is more than a change of behavior patterns, rather, it is an 
existential reorientation." 
Stephanie and her mother both recognized this and pointed it out. As her 
mother said, "She is more mature, more responsible." 
JAMES D. YODER, Ph.D., is a licensed psychologist and director of the Kansas City Chapter ofthe Institute ofLogotherapy, and a certified logo therapist. He also is an adjunct graduate professor ofthe University ofMissouri. 
REFERENCES 
l. Frankl, V. E. Psychotherapy and Existentialism. New York, Simon & Schuster, I 967, pp. 75, 156. 
2. 
Frankl, V. E. The Unconscious God. New York, Simon & Schuster, 1975, p. 27. 

3. 
Jepsen, C. H. "Dentistry," in J. B. Fabry, R. Bulka, and W. Sahakian, eds., Logotherapy in Action. New York, Jason Aronson, Inc., 1979. 


21 
Paradise Lost? Betwixt and Between 
Christopher R. Stones 
In contemporary Western culture we find ourselves caught between two conflicting cosmologies. On the one hand, our scientific orientation is pertinent to account for our everyday existence, lived largely in a technocracy. However, on the other, a religious (in the broadest sense of the word) cosmology is still required to comprehend transcending aspects ofour lives. Because the impact of secularization makes us refuse to acknowledge mystery and transcendency we are, as we face death, remorse, and unpredictability, left with a void, believing that our suffering has little meaning other than what can be accounted for in terms of a scientific ethos. What is lacking is a sense of ultimate direction-a goal to fulfill beyond the aims striven for by technological expertise. 
Logotherapy, being a philosophy as well as a science, points a way to bridge these two cosmologies. Scientists often accuse logotherapy of being "nothing but a religion"-based on unquantifiable observations and unrepeatable experimentation with unique individuals. Yet, the strength oflogotherapy is precisely its refusal to see the human being reduced to "nothing but a thing" that can be completely explained by quantifiable and repeatable experimentation. Logotherapy dares to use the term "human spirit," not as a special characteristic ofthe religious person but as the essence of every human being, religious and nonreligious. 
Logotherapy bridges the gap between the two cosmologies in three areas: The rejection of reductionism, the area of the specifically human dimension of the spirit, and the role of science-not only what science has done for us but also what it has done to us. 
Reductionism 
Frankl illustrates the a priori reductionism of human nature by the story of the rabbi who was consulted by two men. The first contended that his neighbor's cat had eaten five kilograms of butter. The owner ofthe cat emphatically denied this, whereuupon the rabbi weighed the cat and behold: it weighed exactly five kilograms. Turning to the men, the rabbi mused, "Now I have the butter but where is the cat?" 
22 
The anecdote reflects that the type of answer received depends to a great extent on one's basic assumptions and on the type of question posed. Where do we find the essence of a person? Ifwe confine our investigation to the biological dimensions, our answers will be largely restricted to a biological framework. If we embark on a reductionism a priori that the human being is nothing but an animal, we cannot discover anything else. Similarly, ifwe limit our questions to the human person as a psychological being, we receive answers within the psychological dimension of being. 
Frankl illustrates his two laws of dimensional ontology by geometric concepts.6 The first law states that any given phenomenon, when projected out of its own dimension into dimensions lower than its own, is depicted in such a way that the individual projections contradict one another. A cylinder, for instance, if projected sideways, appears as a rectangle, while, in a downward projection it appears as a circle. Yet both of these different two-dimensional figures are projections of one and the same reality: the cylinder. 
The second law of dimensional ontology states that different phenomena projected out of their own dimensions into those lower than their own are depicted in such a manner that the projections are ambiguous. Cylinders, cones, and spheres projected downwards all appear as circles. Looking only at the two-dimensional projections we cannot tell what is their three-dimensional reality. Similarly, a Roosevelt cannot be distinguished from other "cripples," a Dostoyevski cannot be distinguished from other epileptics, if they are seen only in the physical or psychological dimension. 
Following the principles ofdimensional ontology, a reductionistic framework does not allow for a comprehensive understanding of a person. In attempting to comprehend human beings in their uniqueness we must search for their essence, not in the somatic or psychological dimensions but in their "higher" dimension of the human spirit where values and meanings are prime motivators. "Higher" does not imply a value judgement-a "higher" dimension merely is the more inclusive,just as a three-dimensional cube includes its base, the two-dimensional square. 
The Human Spirit 
Frankl,6-7 together with other psychologists and phenomenologists, sees the nature ofthe human being as transcendental rather than encapsulated in subjectivity. The essence of the human person is the dimension of the spirit where values and meanings are sought. Charlotte Biihler4 conceives of 
"... man as living with intentionality, which means living with a purpose. The purpose is to give meaning to life ... The individual ... wants to create values. [Even more], ... the human being [has] ... a primary or native orientation in the direction of creating, and of values." (p. 54) 
These values are to be found in the world and hence it is important to view phenomena in the context of today's man or woman in today's world. But we are not. We need a new cosmology replete with a set of values and a code of ethics. Frankl6 has shown that approximately 20 per cent of the typical 
clinical case load ofpresent-day neuroses originate in a lack of meaning resulting in an existential vacuum which manifests itself as a feeling of boredom and apathy. We no longer have a rigid code ofethics because traditional values have largely fallen away. Yet these Values provided a code of do's and dont's, a direction which we had to maintain or suffer the consequences. 
Although it is true that ethics are a result ofone's culture, they are not entirely culture bound, and are therefore relative. We are using this awareness ofcultural relativity to support a culture-free mode ofexistence-without ethics, tradition, and values. 
Today's youth look to values and ideals only to find a doctrine ofrelativity, a myriad of choices. This results in freedom but also in boredom and confusion. Freedom is apt to become synonymous with a sense of lack-of not belonging. 
Following Maslow's thinking it can be argued that in our affluent society, having satisfied our lower-hierarchy needs, we are motivated to satisfy our meta-needs for meanings and values. Yet, by these very processes which activated the meta-needs, we are barred from fulfilling them. When we ask the question "What has modern technology done for us?" the answer comes echoing that it has given us material wealth and security. But once we ask the question "What has modern technology done to us?" the answer we receive is, perhaps, not so optimistic. Modern technology has denied our spirituality. It has disavowed an essential part of human nature. 
The Role of Science 
Numerous theorists 1,3, 13 assert that contemporary technological life has removed much meaning from our daily work which takes up almost 60 per cent of our waking life. This loss of meaning arises from our need to be related to our potentials in a holistic way. We must feel that we are participating in a meaningful project. Yet technological expertise has reduced our work to a meaningless occupation. Work has become specialized and fragmented to such an extent that most people find it difficult to perceive the relationship between their daily work and their lives. 
Abraham Maslow 13 proposes that we have needs which, once activated, must be fulfilled. He sees our motivation in satisfying our needs emerging in an hierarchical form: first, our basic needs for survival, safety and security, then our social and affiliative needs, and our needs for self-esteem and independence. Having gratified these needs, and as the motivation for self-actualization and self-transcendence emerges, we begin to strive toward actualizing our potential and spiritual needs, our "meta-needs" for meanings and values. The important aspect of this hierarchy is that satisfaction of the lower needs results in the emergence of the higher-level needs. Once released, these higher needs demand gratification if we are not to become frustrated, bored, and apathetic. 
For most people in Western affluent society, the lower needs are satisfied, thus activating the motivation for self-actualization and self-transcendence. Most people in our culture should now be seeking maximum fulfillment of values and meaning in the world. We should be the most fulfilled and satisfied generation that has ever lived. 
As Erich Fromm8 puts it, freedom can become a burden too heavy for us to carry. He asserts that although there is a positive aspect of "freedom to"-for example the freedom to be responsible and to make choices-there is also the negative aspect of freedom, "freedom from"-codes of behavior and from tradition; in fact, freedom from any real need to accept responsibility for one's actions. This negative freedom has become increasingly prevalent during this century. We have been freed from the bondage of economic and political ties, but at the same time we were cut off from the very ties which bring security and a feeling of belonging. Life is no longer lived in a closed world-the center of which holds the human creature. The world has become limitless and also threatening. By losing our fixed place in a closed world we have lost the answers to the meaning of our lives. 
Displacement of Religion 
Fromm9 and others 5. io, 15-16 argue that our Western culture is possibly the first totally secular culture and that, as a culture, we have disbanded concern with the fundamental issues of human existence. We no longer appear to be concerned with the ultimate meaning of life because the solution may be economically nonviable, and there is the tacit assumption that religion is irrelevant, at least, to life within a technology. 
Clearly, the attitudes and procedures of the scientific cosmology are different from those ofa traditional religious framework. Science, for example, is public; hypotheses are presented and investigated in an objective fashion. Anyone is able to rethink and rework the data and arrive at conclusions similar to those of the original investigator. Religion, however, is profoundly personal. The concept of religion is seen in its literal sense-religare, the binding together, the relationship of the total person to the totality of the cosmos. The religious person and the scientist qua scientist dialogue about their concerns in a different manner, and the implications of their dialogues differ in their reference to the ultimacy of one's life. Furthermore, the social character of religion does not make it truly public, because the interpretations and manifestations ofthe same reality vary from sect to sect, and the event which is interpreted may be a private peak-experience or an everyday occurrence which the religious person considers a manifestation ofthe divine. Whatever the interpretation, however, it cannot be assimilated into the scientific world-view because the procedures for collecting data were never valid within a scientific framework, and the phenomenon is of the wrong order for a scientific perspective; it is not quantified and, even if it could be quantified, its inherent ontological status is thereby reduced, if not totally annihilated. In short, science and religion are different ways ofdescribing the world. 2,12Thus, the growth ofscience over the last three centuries has had the effect ofdisplacing God as a principle ofexplanation. Natural law has effectively displaced divine intervention and purpose in explaining events. 
God as a theoretical necessity or scientific hypothesis is "dead." Yet we human 
beings are fundamentally transcendental and intentional beings who need to be 
related to phenomena beyond our individual selves. What better meaning is 
there than one which is so broad and encompassing that it imparts meaning to 
25 
all other meanings? I refer to the meaning found in the value ofa universal law or universal ethic; of a law laid down by a Universal Power which can be seen in either religious or secular terms. 
To understand this we have to see the human being within an expansionistic rather than a reductionistic framework. Yet, our scientific cosmology is reductionistic: all phenomena are explained at the lowest level possible, and ultimately that which cannot be explained in terms of a reductionistic framework is considered either unworthy of study or nonexistent. 
True, human beings can be explained at the level of neurology, but then we have explained them at that level only-a level which does not account for the experience of love, despair, sorrow, hate, and meanings, to mention but a few. 
Human nature can only be fully understood and accounted for from a context of our "highest" dimension-at the level of the human spirit. However, the notion of humans as spiritual beings is nonviable within the world view of the natural scientific cosmology. 
But what becomes of the world purged of its sacramental capacities? 
"It dies the death of the spirit. It may retain for some its pleasing aesthetic surface, but that is of little significance. Beauty cut loose of its sacramental base is a decadent pleasure, and a vulnerable one. For most, the desacralized world is doomed to become an obstacle inviting conquest, a mere object. Like the animal or the slave who is understood to have no soul, it becomes a thing of subhuman status to be worked, used up, exploited. "15, P· 127 
Past transcending concerns served to enrich the lives of men and women by confronting them with a realm ofthe ineffable and ofwonder. It helped to relate them intimately with the workings of the cosmos, 11 even if such relatedness required an act of faith; and, as Roszak 14 comments: 
"The truth of the matter is: no society, not even our severely secularized technocracy, can ever dispense with mystery and magical ritual." (p. 148) 
In conclusion then, a schism exists in our cultural belief system. Twentieth
century cosmology is, in essence, part and parcel of the scientific cosmology 
which has given us the view we have ofthe world today. But it is also fundamen
tally a reductionistic framework which although adequately explaining the 
world as we now know it, it does not allow for an expression ofour transcending 
concerns-our spirituality. Such a cosmology is unable to account for our 
experience of values and meanings that we find beyond ourselves. Traditional 
theological cosmology, on the other hand, does indeed account for and express 
this "beyondness," but it falls short when called upon to account for the world as 
we now know it to be. So where are we-twentieth-century men and women? 
First of all we have covered up our spirituality. Second, we must either bury 
what is already dead-the dichotomy between religion and science-and go 
forward into a landscape of increasing strangeness, exploring new areas where 
religion and science blend. This, ofcourse, will require the development ofa new 
cosmology, the beginnings ofwhich can be seen in both the foundations and the structure of logotherapy. Alternatively, we must become the plagiarist of our own past, a course of action which will be ill advised if not impossible. 
CHRISTOPHER R. STONES, Ph.D., is a permanent faculty member ofthe Department of Psychology, Rhodes University, Grahamtuwn, South Africa. 
REFERENCES 
I. Argyris, C. Integrating the Individual and the Organization. New York, John Wiley and Sons, 1964. 
2. 
Berger, P. L. The Sacred Canopy. New York, Anchor Books, 1969. 

3. 
Blauner, R. Alienation and Freedom. Chicago, Chicago University Press, 1964. 

4. 
Biihler, C. "Some Observations on the Psychology of the Third Force." Journal of Humanistic Psychology, 1965, 5, 54. 

5. 
Edwards, D. L. Relilgion and Change. London, Hodder and Stoughton, 1970. 6 .Frankl, V. E. The Will to Meaning. London, Souvenir Press, 1971. 


7. 
___ 1he Unconscious God. London, Hodder and Stoughton, 1977. 

8. 
Fromm, E. The Fear of Freedom. London, Routledge and Kcgan Paul, 1960. 

9. 
___ The Sane Society. London, Routledge and Kegan Paul, 1963. 


IO. Judah, J. Stillson. Hare Krishna and the Counter Culture. New York, John Wiley and Sons, 1974. 
11. 
Larue, G. A. Ancient Myth and Modern Man. New Jersey, Prentice Hall, 1975. 

12. 
Maslow, A.H. Toward a Psychology of Being. (2nd ed.) New York, Van Nostrand, 1968. 

13. 
Pearlin, L. I. "Alienation from Work." American Sociological Review, 1962, 27, 314-326. 

14. 
Roszak, T. The Making ofa Counter Culture. London, Faber and Faber, 1971. 


15. 
____ Where the Wasteland Ends. London, Faber and Faber, 1974. 

16. 
____ Unfinished Animal. London, Faber and Faber, 1976. 


27 
Treatment of Snake Phobia 
Combining Paradoxical Intention with Behavior Modification 
George Sargent 
Miss W referred herself to our clinic complaining of adjustment problems to her year-old divorce. In the course ofthe therapy she requested help with a snake phobia which had plagued her for as long as she could remember. When asked whether this classic phobia was in fact causing her any real discomfort in her modern, coastal, non-snake-infested environment, she affirmed vehemently that it was. She first gave examples of her married life on a ranch in the western United States in an area heavily populated with rattlesnakes. While she lived there with her husband and children for many years she seldom dared to venture out of the house because of her fear of being attacked by a snake. More currently, she gave examples from her art class where she could not even bring herself to draw the outline of a snake, let alone paint one in detail. She related recent incidents where a well-intentioned art teacher asked her simply to draw the wiggly form of a snake. Miss W was unable to complete the picture. She began sweating and shaking and finally requested another member of the class to put the painting away in the closet. Even after this point she could not look at the closet without feeling a shudder, and she could not force herself to approach the closet to retrieve her painting. Miss W also related incidents in her study of psychology, particularly in the area of phobias, where she continuously ran across pictures ofall shapes and sizes ofsnakes, and this caused her considerable anxiety. It even interfered with her enjoyment of movies. She related several recent films where the sudden appearance of a snake played a prominent part. 
Miss W had a long history of difficulties with her husband, who came from a wealthy western family, and in the course oftheir disagreements and impending divorce she had become severely depressed. She had been hospitalized in a luxurious, private mental institution back east where her husband had joined her for several long stays in an attempt to work out their partnership. In total she had received approximately seven months of in-patient psychotherapy at this hospital, over a period of two briefly separated stays, and had seen a number of psychiatrists. One psychiatrist had attempted to deal with the snake phobia, upon her request, along the lines of Freudian analysis, but his interpretations of her phobic condition (particularly his emphasis on the phallic symbolization of snakes) did not noticeably improve her problem. Several other therapists refused to deal with her phobic condition, despite her request for help with it. 
28 
My original intention was to attempt a progressive desensitization using Solpe's technique of reciprocal inhibition. The client was given one session of practice in relaxation and focusing, and another session and one-half was spent constructing a hierarchy of progressively more disturbing images concerned with snakes and snake-like figures. At the fourth visit the items were presented to Miss W beginning with the least threatening and working up to the fifth item from the bottom in a 15 item hierarchy, but we could not seem to get beyond this point. At the next session this item (visualizing a snake loose in the client's immediate neighborhood-an item drawn from her own experience) was moved higher up in the hierarchy and another item seemingly less threatening substituted. Again we could not progress further through the hierarchy than we had before. I then turned to Frankl's technique of paradoxical intention. 
A Favorite Snake Room 
I instructed Miss W to begin using paradoxical intention at her home. She lived in a large house and was by herself most of the time. I had her pick a room in the house which she wanted to convert into her "favorite snake room." Demonstrating with a closet in our therapy room I opened the door, walked in the room and began to say "hello"to all my snake friends, calling them by name, reaching out to pet them, saying how good it was to be with them and the like, trying to use both a combination of humor and fantasy. My client, rather than being greatly upset by this mentioning of snakes (which would have not been unusual for her) was amused although slightly nervous. I had her immediately get up and do the same thing. Having a theatrical flair, she mimicked my actions quite well, and added several of her own flourishes. I then prescribed for her an additional task. She was to sit down with a book once each day, pretending that it was a book filled with snake pictures, leafing leisurely, but with great enjoyment, through each page. She was to dwell at length on the beautiful pictures of her "favorite" snakes and feel great anticipation as she turned each page (loving snakes as much as she did). 
The next session it was apparent that Miss W had done a great deal of practicing in her room at home. She had chosen her bathroom as her pet room and related with minor embarrassment her amusement that her neighbor might have overheard her talking to her snakes one morning. She had, in her fantasy snake room, draped snakes over the towel racks, had them swimming in the bathroom sink and even swimming in the tank to her toilet. Before she flushed she would yell, "Hang on fellas, here it goes!" When she told this we both laughed. She behaved animated and obviously felt good about her achievements. She had also spent at least some time every day "breathlessly racing through her picture books of snakes." 
Miss W had only one anxiety attack during the brief period while paradoxical intention was being applied. One morning, while taking a shower, she had the feeling that snakes were around her feet and crawling up her legs, and this threw her into a mild panic. I therefore instructed her to make a point each morning of opening her shower door and asking all her "friends" to leave while she took her shower because, "she deserved at least that amount of privacy." She made a ritual out of this and reported no further anxiety attacks while practicing her snake routine. 
29 
Post PI Treatment 
After two more sessions (of which the relating of the paradoxical intention and the incidents with the snakes took only 15 minutes to half-an-hour), we began again to use behavioral modification techniques. This time we were able to come in at a much higher level in the hierarchy. We first practiced talking about snakes and later looked together through an actual picture book of snakes. This was anxiety-provoking, but Miss W continually expressed her willingness to go on. One day was spent trying to draw snakes on news pad with pastels, a task in which she performed admirably with little anxiety. Finally we set up an appointment to do invivo-desensitization in the snake house at the San Diego Zoo. We spent a good amount oftime at each ofthe windows ofthe snake exhibit, and a great amount of time studying the snakes in detail. The process took approximately an hour. Miss W was nervous and made many jokes about the appearance ofthe snakes. I was concerned about the effect ofthe experience on her, but she reported only mild anxiety. Two days later I received a call from Miss W. She was upset, felt that she had cut herself off from the real effects ofthe zoo experience at the time and wanted to talk about it. When she came in she also reported that for the first time ever in her life she had had a nightmare about snakes. I immediately said, "Good, that's perfect, that is real progress." I assured her that her beginning to have dreams about snakes was a breakthrough in her phobia therapy. She brightened upon hearing this and there was no further incident ofeither dreaming ofsnakes or her recurring anxiety attacks. From this point on her anxiety about snakes diminished to the point where we conducted an invivo-desensitization in the office with a live snake enclosed in a terrarium. She came as close as three feet, which was as close as she really needed to get to a snake, she said. 
At approximately the same point in therapy that Miss W had her dream about snakes, she was also facing several situations in her life in which she had not been able to express appropriate anger adequately. Her style was to "swallow" her anger and internalize it, and we had been working on her more effective expression of this emotion. At this point, however, the connection between the snakes as a symbolization of the male penis, aggression, and anger, seemed to make sense to her in a way it never had before. This seemed to free her up to be more sharing with her anger and more open with it, which in turn allowed her to feel more free with herself and others. Miss W has been symptom-free for a period of two years, and there is no anticipation that further therapy with her snake phobia is needed. She has made increasing progress in being aware of her anger and expressing it more openly to others as appropriate. 
GEORGE SARGENT, Ph.D., is clinical psychologist at the Family Center, Vista, California. 
30 
"THERE'S SOMETHING ABOUT THAT NAME" 
William L. Hanks, Jr. 

Then God said, 'And now we will make human beings; they will be like us and resemble us. They will have power over the fish, the birds, and all animals, domestic and wild, large and small. ' 
(Gen. 1:26-31, Today'.5 English Version) 
Then the Lord God said, 'It is not goodfor the man to live alone. I will make a suitable companion to help him.' So he took some soil from the ground andformed all the animals and all the birds. Then he hrought them to the man to see what he would name them; and that is how they all got their names. So the man named all the birds and all the animals; ... 
(Gen. 2:l8-20a, Today's English Version) 
At least by implication, the having power over and the naming of the beasts of the field, the birds ofthe air, and the fish of the sea, are intimately tied together. The naming phenomena can work for us as well as against us. 
One example ofthe negative effect ofthe naming phenomena is the loss ofthe "fuzziness" as a result of overusing the word "fuzzy." The same is true with all overused words-they become cliches, meaningless. Maybe such a phenomenon was one of the reasons behind the Hebrews' prohibition to say the word, "Yahweh." Ifthe naming means dominion over the named, then the not-naming may keep the magic at least in the mind of the potential namer for the not-named reality. Surely the naming docs not infringe upon the person of God, but naming docs seem to give the namer a false sense of familiarity that may breed "surety" rather than faith. Walker Percy in his book, Message in the Bottle, 1says that the direct and wide use of the theological language to convey the Gospel has quashed the very truth the language was to convey. 
An example of the positive effect of naming is the subject of this writing. If naming tends to objectify and control that which is named, then naming a fear can provide some objectifying of that fear, and therefore decrease the power of the fear and its concomitant results. Here are two examples. 
Mr. J came to my office complaining of chest pains along with various other symptoms. I inquired ifhe had seen a physician, and he said he had. I received a release from Mr. J to discuss his symptoms with the physician, who told me that Mr. J had been checked by him and also by two other physicians. They all agreed that Mr. J was suffering from something other than a possible heart attack. I explained the use of paradoxical intention and asked if he, the physician, thought Mr. J would be in any physical danger if I used this logotherapeutic technique. The physician thought my proposal was in order. Therefore, the following scenario between Mr. J and me took place. 
31 
We discussed the possibility ofsomething other than a physical heart problem as the cause of his pain. He agreed to work with me and "Mr. Lapsaday,"which was the name I gave to his anticipatory anxiety. Mr. J was instructed to be generous with Mr. Lapsaday at all times. He was to invite Mr. Lapsaday for a visit at any time Mr. Lapsaday called or came by. Moreover, Mr. J was to insist on a visit from Mr. Lapsaday once in the morning, once at noon, and once before brushing his teeth in the evening. 
By the next counseling session Mr. J's symptoms had drastically decreased. He was addressing Mr. Lapsaday as a real person, and developing a relationship with him. A sense of objective distance was established between Mr. J and his symptoms, alias Mr. Lapsaday. Along with the naming went some built-in humor and some healthy ridicule. Mr. J and I were able to observe Mr. Lapsaday from the "outside," with no ill effect to Mr. J. Actually, the more we talked about Mr. Lapsaday, the less powerful he became. Before long, Mr. Lapsaday became a bore and only needed recognition of existence to effect his no-existence which allowed Mr. J a rather healthy existence. 
Another scenario: "Miss Lapsaday" became a frequent visitor ofa 16-year old high school junior, Joan. Joan came to me via her parents because of asthma attacks that happened frequently when at school. The attacks rarely came when she was out of school. I went through the same process with the attending physician as I had done with Mr. J, and began therapy. Joan and I discussed her problem, and I asked her to play a game with me and "Miss Lapsaday." By the way, it is up to the patient to decide whether the member of the "Lapsaday" family is old, young, black, white, male or female. The three of us, Joan, Miss Lapsaday, and I talked about how we would deal with the "asthma." I told Joan to invite Miss Lapsaday in the moment she noticed her presence. Miss Lapsaday loves hats, so I asked Joan to wear her father's fishing hat backwards and turn up the bill and model for Miss Lapsaday and herself in the mirror for one minute whenever she knew Miss Lapsaday was around. (Miss Lapsaday, although loving hats, hates fishing hats, and often leaves the premises when she sees one-sounds like a phobic reaction to me.) Joan was to have at least one visit per day from Miss Lapsaday while in school. Also, Joan was directed to encourage Miss Lapsaday to visit with her at home at least three times a day. Joan was likewise encouraged to converse with Miss Lapsaday as much as possible during each visit. The more Joan invited Miss Lapsaday for a visit at home, the less Miss Lapsaday would visit. The more Joan talked with Miss Lapsaday, the less traumatic the visit and the less frequent the visits. 
Joan was somewhat disappointed when she actually went to school the next week with Miss Lapsaday. She had some recurring visits, but because the relationship between her and Miss Lapsaday was rather funny and intimate, the visits became shorter and less severe. 
The inclusion ofa name served to produce subjective objectivity. The distance produced by the naming released the patients from their symptom by giving them power over that symptom. The power came from the naming, and the humorous relationship with the created personality of "Lapsaday." The humor and different imaginary relationships let the person deal with a fearful thing in 
32 
the "Land of Lapsadaysia." This approach actually combines three distancmg phenomena: (I) the paradoxical intention itself; (2) the subjective namingLapsaday; and (3) the humorous dialogue with a member of the "Lapsaday" family, and the concomitant humorous actions as a result of the relationship between the patient and "Lapsaday." 
I'm not sure about all the theories working here, except that they are based on the logotherapeutic concepts ofself-distancing and paradoxical intention. But I do know that my patients are enhanced beyond therapy or techniques. "Mr. and Miss Lapsaday" further humanizes our relationship and opens my patients up to the point of relating, with gentle humor, to their not-so-likeable selves. And, FRANKLY, I am enjoying the whole process while I learn the magic of the human spirit. 
WILLIAM L. HANKS, JR., Ed.D., is the director ofThe Carpenter's House, an individual andfamily counseling and education center in Mobile, Alabama. 
REFERENCES 
I. Percy, Walker. The Message in the Bottle. New York, Farrar, Straus and Giroux, 1978. 
C. S. Lewis: 
Ifthe whole universe has no meaning, we shouldnever have found out that it has no meaning.-just as, ifthere were no light in the universe and therefore no creatures with eyes, we should never know it was dark. 
33 
Logotherapy in Prison 
Michael F. Whiddon 
Based on the assumption that the multiple causes for criminal behavior may include an absence of meaning in life, a logotherapy program was designed for men in a state penitentiary. This program was designed to help incarcerated adults identify purpose and meaning in their lives on which they might build non-criminal lifestyles. During this program, an attempt was made to assess the role ofabsence of meaning or existential vacuum in the development ofcriminal lifestyJes. 
Over a period of 18 months, 115 men participated in logotherapy groups. This report describes the initial logotherapy program. 
The Group 
First, 1,734 men in the penitentiary were given a brief description oflogotherapeutic philosophy through the prison newspaper and were invited to participate in a group experience. Because no one volunteered, a subsequent announcement offered increased visitation privileges for participants. Fortythree men volunteered, including 17 who were bad security risks due to recent escape attempts and violent behavior. Ofthe 26 men who began the group, three were paroled and three others chose to drop out early in the group process. 
Of the 20 men who participated, 14 were between the ages of 27 and 33, four were younger than 25, and two were older than 50. Eleven were white and nine were black. Seventeen men had a high school diploma. Sixteen men had convictions for one or more violent crimes, including armed robbery (12), murder (3), assault (4), escape (3), and rape (I). Four men were serving time for drug-related charges. All of them had previous arrests and incarcerations. Fifteen men reported that the use of alcohol or drugs had seriously affected at least one major sphere oftheir lives, contributing directly to the incarceration of six of them. The major reasons reported for having committed crimes were: money, peer pressure, reduced judgment or control because of drug abuse, and the desire to impress peers through high-risk behaviors. 
In comparison with the general prison population, these men were significantly older and more educated. There were virtually no differences from the general prison population in terms of percentage of violent crimes and number ofconvictions. None ofthe men accepted into the group had committed a major rule infraction for six months. They all reported increased visitation as primary motivation for joining the group. Six also reported a desire for personal growth. 
Pretreatment scores on the Purpose-in-Life test2 averaged 81 with a range of 70 to 116. These scores are below that expected for groups with high purpose and meaning in life. 
34 
The Treatment Program 
Twenty men from six different housing units were brought together for group meetings. They met three hours per night, three nights per week for 24 weeks. Two nights per week, logotherapy activities were led by this writer. One night the group met in self-guided discussion/rap sessions without a therapist. 
This logotherapy program, designed to assist incarcerated adults in finding a purpose and meaning in their lives that may lead to rehabilitation, was largely based on James Crumbaugh's book Everything to Gain: A guide to selffulfillment through logoanalysis. 1 Exercises were taken from this book and other sources to help the men become aware of their resources and values. The Socratic dialogue was used extensively with the men to help them try to discover meanings for themselves. 
The program consisted offive distinctive phases: ( 1) psychoeducational training in the principles oflogotherapy; (2) expansion ofself-awareness; (3) restructuring ofself-esteem/ self-image; ( 4) dereflection toward values/ societal implications; and (5) development of personal meaning, goals, and implications for future behavior. 
In the first phase (four weeks) the principles underlying logotherapy were presented. Theories concerning how criminal behavior can grow out ofexistential vacuum were discussed, as were examples of how individual men in prison had redirected their lives upon finding purpose. The men were also encouraged to reveal their own criminal histories and behavior as they might relate to these principles and theories. 
Phase two (five weeks) attempted to expand each individual's awareness of him-or herself. Exercises were conducted to help them identify a wide variety of experiences, their strengths and weaknesses, their fears and desires, their environmental circumstances, and their potentialities. Each ofthese were discussed in terms of underlying meanings and motivations. 
Phase three (four weeks) consisted of a series ofexercises aimed at increasing the self-esteem of these men, instilling confidence in abilities, and stimulating hope for future potential. Discussions, group suggestive therapy, guided imagery, and positive affirmations were used to increase self-esteem and combat the constant environmental pressure to perceive oneself as a "criminal." 
During the first three phases the emphasis of activity had been for the individual to focus on the self. The fourth phase (six weeks) changed the focus from attention to the self to attention to other life values. A wide variety oftopics were presented and debated by the group. Values were clarified, and societal implications and expectances were discussed. This group dereflection phase was extensive, setting the stage for taking a stand on issues and identifying those values that had personal meaning. 
The final phase (five weeks) challenged the participants to draw on their expanded understanding of themselves and their values to identify the meaning and purpose of their lives. Exercises were conducted to develop short-and long-range goals that were consistent with these meanings. 
At this point in the logotherapy program, the individual meanings and plans were discussed in terms oftheir implications for future behavior and self-image. The concept of being free to decide to live a productive, non-criminal lifestyle was reinforced, as was the philosophy that having a meaning and purpose is an essential element in filling one's existential vacuum and providing the motivation and strength for making appropriate decisions and facing life's problems. 
The Results 
The effects of this program were evaluated in several different areas. Reports of life meanings after the group were compared to those reported for the time period during which crimes were committed. Post-group Purpose-in-Life test scores were compared with pre-group scores. Behavior during the group was monitored for rules infractions. Finally, a two-year follow-up was conducted to determine the presence or absence of criminal lifestyles. 
In comparing changes in reported life purpose, the following results were noted. Eighteen of these men described the time in which they began criminal activity as a period in which they were without a directing life meaning. They reported few, if any, goals in life. They felt bored and worthless, and they had few beliefs in the existence ofme,:ning in life, order to the universe, or in free will to find meaning in life. One man reported a desire to become the most successful criminal in the area, and another man had wanted to become a teacher, with criminal activities seen as a method of financing his education. After the group, every man had developed a set of short-and long-range plans that related to values identified and goals set in the group. Six men reported (and were seen by this writer) as having discovered meaning that was directing their life. Twelve men reported moderate success in having found meaning in that they had discovered new interest. self-esteem, and direction for the future. Two men reported only discovery of possible alternatives for future attempts to gain release or find work. 
Post-group scores on the Purpose-in-Life test improved for every group 
member. The average score had increased from 81 to 96. Fourteen men had 
scores above the cutoff score of 100 reported to reflect a purpose and meaning in 
life. 2 These positive test score changes are consistent with changes noted in other 
logotherapy programs conducted with incarcerated adults (Guidera and Whid
don)4 and with chronic mental patients.3 Guidera and Whiddon4 found an 
average increase of nine points (post-test average 93) on the Purpose-in-Life test 
for prisoners exposed to a brief logotherapy program. At the same time a 
control group of prisoners showed a 3-point increase and a group of prisoners 
spending an equal amount of time at a religious seminar showed a 2-point 
decrease in Purpose-in-Life test scores. 
Behavioral monitoring indicated that the group maintained a record of no 
disciplinary infractions. Group cohesion developed to the point that the group 
spontaneously requested that they be housed together to be able to "live in a 
clean, safe environment." Subsequently these men were moved to a unit and 
developed a self-governing therapeutic community which functioned for 18 
months without armed guards or disciplinary problems. No other housing unit 
in the prison maintained such a record. 
36 
A two-year follow-up revealed that 9 men had been released from prison on parole or work release. One of these men had returned to prison with a new criminal charge. Parole supervisors reported no indication of return to criminal lifestyles for the other eight. 
Of the I I men remaining in prison, five had been released from the main institution to trustee status work centers around the state and were awaiting their parole consideration dates. The six men remaining in prison had all achieved trustee work assignments and were functioning without disciplinary pro bl ems. Two of them had been denied parole because of the severity of their crimes. Four were awaiting release consideration dates. 
Postscript 
Subsequent to this program, five additional groups were conducted (three months each) in which 89 men participated. These groups met within the therapeutic community formed by the first group, with members of that group functioning as co-facilitators with this author. Positive Purpose-in-Life score changes and appropriate behavior results were similar in each of these groups. Seventeen men dropped out oftherapy and three were asked to leave by vote of the therapeutic community. All of these who did not complete a group were below 25 years of age. Follow-up data on all groups are being collected. 
Discussion 
Based on the data presented above, it does appear that a connection may exist between existential vacuum and the etiology of criminal behavior. Before application oflogotherapy the scores for these prisoners on the Purpose-in-Life test were significantly below that of groups for which one would assume a high sense of purpose and meaning in life. These men were without a directing life meaning, increasing the potential for maladaptive behavior. Normal values, such as those of life, property, and respectability, did not exist. Attempts to fill their void focused on the present moment, crowding out thoughts of the future-of the consequences of behavior. Sensation seeking activities and drug abuse helped them escape the feeling of being unimportant. Viewed in this manner, it appears that an absence ofmeaning in life may lead to self-destructive behavior, including criminal activity. 
Claiming effectiveness for this logotherapy program in rehabilitating incarcerated adults must be done cautiously. Positive changes in Purpose-in-Life test scores can be documented, as can self-reports of discovery of meaning. More importantly, for these men in-prison behavior and small samples of out-ofprison behavior have shown changes in lifestyle that are consistent with new life goals and therefore preclude criminal behavior. Inside a setting that festers with violence and dehumanization, these men began living appropriate lifestyles. It is hoped that their search for personal meaning contributed to these changes. I believe that many persons in our prisons would benefit from logotherapy. 
37 
Case Examples 
Case One was a 28-year-old white male who had served 11 years of a 24-year sentence for bank robbery, prison escape, and kidnapping. For several years in prison he had created much trouble, but had been a model prisoner for two years. At the beginning ofthe group, he reported that he had decided not to be a criminal and wanted to develop a productive life. He had no specific plans for the future, but was within three years of parole consideration. In looking at his experiences and the values underlying them, he described much of his criminal behavior as coming from a desire to be important and to gain publicity. He wanted to be a leader and had led others in criminal ways. It also became evident that he felt that the past dozen years had been wasted. Helping to lead others from wasting their lives in crime provided meaning for him. Indeed, he felt a responsibility to help others because it would make sense ofhis life experiences. 
Based on this meaning for his life, he set himself the goal of helping rehabilitate criminals, especially young people. He began by participating in the development of a therapeutic community within the prison. From there he contacted counselors who worked with juvenile probationers and helped set up opportunities to talk with young people about how he had begun his life of crime and the wasted time that had resulted. He had discovered a meaning that gave him something to live for. In addition, this meaning required living a noncriminal lifestyle. 
Upon follow-up, this man was still one year from parole consideration. Despite being in prison, however, he had achieved a work assignment in a jail setting outside the main penitentiary. He worked as janitorial help in a county courthouse in the morning and counseling juvenile probationers in the afternoon. Other life changes included having met and married a youth-court counselor and having begun university classes by correspondence. 
Case Two was a 27-year-old black male serving a life sentence for murder. This man reported a long history of criminal behaviors that had grown out of boredom and dissatisfaction with life. Drugs had provided some escape from his frustration, and criminal exploits were his "only claim to fame" among his peer group. His lifestyle had resulted in the murder of a friend while drunk. 
When the group began, he had served three years, and at least four years remained before parole consideration, His prison record had numerous accounts of rule violations. As he explored his experiences and interests, he found repeated references to creative and experiential values concerning art work and painting. He was encouraged to produce some art which provided him with good feelings about himselfand with positive attention from others. When the group concluded, most ofhis plans used his artistic abilities to help him cope with living in prison and to make a living after his release. The meaning he had found was to produce beauty for others to appreciate while also presenting some messages about how he saw the world. 
Upon follow-up, this man remained in prison waiting for parole consideration still a year away. His behavior in the prison was considered model by the officers and officials who knew him. He had obtained trustee status and worked daily in the penitentiary printing shop where he put his illustrating skills to use. 
38 
He had become active in producing the penitentiary newspaper and worked in a counseling program for juvenile offenders. Finally, he was planning to continue these types of activities upon release. 
Case Three was a 55-year-old black male serving a long sentence for multiple crimes. It was highly probable that release from prison would never occur. He had been in prison about 14 years and had only recently been released from a maximum security lock-up situation. 
Although he expressed many initial doubts that he would benefit, he participated actively in the group exercises and discussions while in the logotherapy program. He ended the group reporting moderate improvement in having a sense of meaning. His goals and plans included seeking a "more comfortable" living within the therapeutic community and finding some job inside the penitentiary at which he could occupy his time. 
Upon follow-up, it was found that the logotherapy experience had led to other experiences in which he discovered meaning. Shortly after the group, while he was in the prison's hospital, a 14-year-old was sent to prison for an armed robbery. This man was asked to room with the boy for the boy's protection. This request was accurately perceived by him as an expression of confidence in the reality of his new style of living. For several weeks he continued to grow in self-esteem while trying to relate to the boy what he had heard and learned in logotherapy. By the time the boy was properly placed in another facility, the man's work had become known and his status at the hospital had grown. This experience and his continued search for what might be meaningful in his life led him to feel that he could repay society in some way by helping others. At present, he continues to behave appropriately, he has volunteered to work in a juvenile probation counseling program, and works at the prison hospital. He may never be able to leave prison, but he has discovered a satisfying, meaningful lifestyle. 
MICHAEL F. WHIDDON, Ph.D., is a clinical psychologist at the Veterans Administration Medical Center at Knoxville, Iowa. At the time ofthis report he was Director of Clinical Services for the State Department of Correction in Mississippi. 
REFERENCES 
I. Crumbaugh, James C. Everything to Gain: A Guide to Self-fulfillment Through Logoanalysis. Chicago, Nelson-Hall, 1973. 
2. 
Crumbaugh, James C. and T. Maholick. The Purpose-in-Life Test. Psychometric Affiliates, 1973. 

3. 
Ellison, G., G. Hare, and M. Whiddon. Purpose-in-Life test score changes and logotherapy with chronic mental patient. (Abstract) Journal of the Mississippi Academy of Science. XXVI (supplement), p. 102. 

4. 
Guidera, T. and M. Whiddon. Changes in Purpose-in-Life test scores and logotherapy with incarcerated adults. (Abstract) Journal of the Mississippi Academy of Science. XXV (supplement), p. 103, 1980. 


39 
Treatment of Existential Frustration 
Vlastimil Siroky 
A medical doctor is often consulted for bodily ailments and symptomatic disorders which cannot be diagnosed as either organic or neurological in nature. While talking to the patients about their subjective world, the physician begins to uncover certain conflicts or psychological problems that are disturbing them. The doctor may discover that the patients are suffering from existential frustration, a lack of meaning in life, which is not necessarily a pathological neurotic symptom but rather a disturbance that develops from the patients' inner disequilibrium and can evolve into a neurosis. 
Thanks to the contribution of the Viennese school of Professor Frankl, constant studies are being made about the medical consequences of a repressed or ignored will to meaning resulting in an existential vacuum and a lack of meaning in one's life. Logotherapy has proved to be a successful treatment to cure neuroses, especially those originating in the specifically human dimension, that is, neuroses not caused by past traumas but present conflicts of values or conflicts of conscience. Frankl's methods are being used by the physicians in the 
CSSR. 1 
The literature on logotherapy makes it possible for practicing physicians to deal effectively with this neurosis, caused by existential frustration. I have used this method frequerltly and am presenting three brief case histories in which logotherapy was used as part of the treatment. 
A 34-year-old divorced woman, living at home after a stay in the hospital entered my office and broke down in tears, sobbing: "My life no longer has meaning ... it would be best to open the gas oven and end it all." This patient had been treated for many years for tuberculosis in a sanatorium. For three years I treated her for a bronchial disturbance which caused the left lung to contract. Because of her lengthy disease, she had developed suicidal tendencies. I advised the patient to go to a psychiatric state clinic at Brno. The following diagnosis was given to me by the clinic: thanatopia (fear of death), depressive symptoms, hopelessness, a feeling of uselessness, a high sense of insecurity, a complete distrust of people, a feeling of entrapment, lack of spontaneity, insomnia, and heart palpitations. After four months oftreatment she was sent home. When she resumed my care, I came to the conclusion that her phobias were based on an existential frustration developed during the period of her lengthy somatic illness because of her hypersensitive personality. This diagnosis indicated to me what Frankl calls a "piggyback" neurosis riding piggyback on a somatic or psychological illness. A patient can develop a neurotic behavior pattern, usually depression, as a consequence ofan illness. While an illness can be cured, or at least kept under control, by medication, the neurotic behavior pattern must be broken. I, therefore, treated the patient not only with medication, but also with the logotherapeutic techniques of self-distancing and a Socratic dialogue. For the practicing physician this therapy is demanding, because it requires him to 
40 
concentrate on helping the patient find new meanings in her life that can pull her 
out of her brooding over her fate and challenge her to new tasks, that are 
meaningful to her. As this patient was a native Bulgarian, she decided to teach 
that language. She found meaning in the fact that she was the only person in the 
city who could help Bulgarian orphans with their native tongue and thus keep 
them in touch with their cultural heritage which she was so proud of. 
The second case was that of a 37-year-old housewife. For many years, I 
treated her for an allergic diathesis which caused a lot of somatic discomfort. 
When her complaints widened to include symptoms that seemed to be psycho
genic she was taken to a psychiatric clinic. From the attending physicians I 
received the following diagnosis: vegetative neurosis with reactive phobias, 
psychoneurotic personality, hypersensitive, introvert. 
After her relase, I treated the patient logotherapeutically. In talking to her about her life, I discovered she was overly dependent on her husband's income and developed headaches and rashes whenever she entered a clothing store. Under my guidance she came to feel that she should get on her own two feet and thereby become independent from her husband's income. She first took a job as a kitchen helper and since then has been working as a cook in a restaurant. From the moment she started her work, she did not need to see any more doctors, though she did come to see me twice during the flu season with throat inflammation. She no longer takes massive doses of medication. 
The third case concerned a 38-year-old housewife. I treated her for years for recurring bladder infections, and she also went to several health resorts. She was treated with many medications some ofwhich brought her relief but I also found her to suffer from existential frustration because she felt useless. She had no children and she felt that her husband did not need her. Her life seemed empty. I therefore treated her with logotherapy in addition to her medication. I encouraged her to make a list of choices open to her. She discovered that she liked people and took a job as a receptionist. For the next two years, she came for a regular weekly consultation, still taking some medication. Today she no longer needs medication. 
From the above I have come to the conclusion that practical physicians would benefit from acquainting themselves with logotherapeutical methodology and read up on its literature, so that they could use this tool in cases similar to those described above. It teaches one to understand human nature in its fullness, and the importance of the will to meaning. When people have given up to search for some meaningful activity or experience, they may see suicide as their only alternative. Logotherapy helps the doctor become more human and act accordingly. The results of logotherapy demonstrate the fact that these methods go beyond the prescription of sedatives and other medications. In many cases logotherapy not only helps the patients to find meaning but also to become more open to relationships with other human beings. 
VLASTIMIL SIROKY, M.D., is a practicing physician in Brno, Czechoslovakia. 
REFERENCES 
I. Kratochvil, S. "Psychotherapy in Existential Frustration." 1957, 3, 186-191. 
41 
In the previous issue of The International Forum for Logo therapy we published the prize-winning essay by Derek L. Dean in our contest for California high-school seniors. Because of the high quality of the runners-up we are publishing two further entries. The theme of the contest was "The Search for Meaning for Youth in the 1980's." 
A Well Beside the Crossroad 
Ginta Palubinkas 
As part of today's youth, I have a dream, a reason for being, a given purpose for merely existing. I am part of the youth of the l 980's, which is here to change not the world but at least one factor in life which will make the world a more comfortable place for all people. This goal is attainable, for if each of us works and acts, to the fullest extent of Pur ability, the world will he the best that it can be. No one should ask more from today's youth; no one should expect less. 
I am a member ofthe world's tomorrow, as well as its yesterday, and its today. What this generation makes of itself today, with the lessons learned from the generations ofyesterday, is what it will pass on to the generations ofthe future. It is my most precious hope that we, the youth of today, will be able to raise our children in a brighter world--a world which has more good than evil within its bounds. We will have failed, as a generation, if we pass on a world filled with fear, pain, despair, or uncertainty, for we will have left the world unchanged. 
I believe that my generation will experience success in achieving its goals, for it has learned the value of an individual, as well as the importance of a group. "Everyone has his own specific vocation or mission in life; everyone must carry out a concrete assignment that demands fulfillment. Therein he cannot be replaced, nor can his life be repeated. Thus, everyone's task is as unique as is his specific opportunity to implement it." These words by Frankl are shared by much of the youth today. 
Many people believe that an individual can accomplish great things. Each person has a talent which can be shared but not duplicated by others. By using our gifts wisely, each one of us can create things of great importance, both to ourselves and to those around us. Each individual may solve problems which afflict the world but, because the power of one person is limited it has to be enhanced by others. The youth ofthe l 980's has realized that to accomplish truly great deeds; to move mountains; to conquer the worst crisis; and to overcome the worst of fears, we, the youth, must unite and support each other in all respects to achieve complete success. We must congress, because, as stated by Frankl,"... the true meaning oflife is to be found in the world rather than within man...."Therefore, in order to find the meaning oflife, we must understand the world, and in order to do this we must first gain a better understanding of each other. 
We have learned that if we band together, if we combine our individual talents, then the youth is able to fulfill its goals more readily and to a greater extent. The youth of the l 980's is determined to be a "we" generation, rather than a "me" generation; working together, we will be able to know each other better. Even so, we have great respect for individuality. As a group, the youth dares to tread a new path: to begin with what it has been offered by previous generations and improve upon this "inheritance," while taking active steps forward, toward the implementation of new ideas, new concepts. Progress is important to youth, but foremost is the belief that we must avoid repeating the same blunders made by the travelers who preceded our generation. We must have the wisdom to retain the knowledge which was left for our benefit, while discarding irrelevant ideas. 
Although the youth of the 1980's treads a relatively new path, carrying a purpose, goals, and intentions which differ from those ofits forerunners, it does not hesitate to blend the old with the new. As the path of present-day life winds itself in various directions, it often crosses paths which were trodden by other generations. Usually there is a well beside the cros~road where the two paths intersect; a well of knowledge left for future generations by the previous ones, Having approached such a well, the youth can choose, wisely, to dip its bucket and draw strength from the philosophies left by the generations of yesteryear, thereby expanding the horizons of its own convictions, or it can choose to pass by the well. 
The wells of knowledge are helpful in times of great need, for they are something to fall back upon in critical moments. When the youth can find no solution for a problem, then it can often find the answer within one of the wells which contains the secrets of all time. Having quenched its thirst for advice, the youth is ready to travel on and, possibly. to leave a few of its own ideas behind, which seep into the well and mingle with the wisdom of the ages. 
The youth ofthe l 980's finds meaning in its accomplishments and, in turn, its accomplishments and ideas reflect the meaning of today's youth. It was once said that a person who dreams has a reason to live. The saying may have just as well been said about the youth of this decade, for it is a generation which is not afraid to dream. 
Each new generation was meant to rebuild, refresh, and give the world new hope for the future. Each generation was meant to give itself a meaning, and to instill meaning into the lives ofothers. The youth ofthe l 980's has done so, for it has a dream-a dream which gives it meaning. It dreams of building a worthwhile future for the children of tomorrow and of preserving the beauty and wisdom of yesterday. 
GINTA PALUBINKAS is agraduatefrom Edison High School, Huntington Beach, California. 
43 

A Creation Myth of Meaning 
Jeffrey Mitchell 
Humankind had completed another full evolutionary cycle by the year 1987. It was the second step in human social evolution, the first occurring after the sinking of Atlantis. Six months after the first nuclear warheads had mushroomed on their targets, 30 per cent ofthe human race was back to living in caves (of course this does not represent a large number of people, because after the war, the Earth's population of human beings was back down to the levels it had attained during the time of Ancient Greece). By 1988 no governments were in existence, the oldest person left alive was 85, and the first myth had evolved. 
The originator of the myth was a 16-year-old girl who at one time had been very fond of Winnie the Pooh. However, due to circumstances beyond her control she had found herselfliving in a small cave with 23 children in her charge after the war had ended. There was no adult alive in a 100-mile radius from her cave. The parents of the children under her auspices had delivered their young ones to the relative safety of the cavern and then promptly died (the teenage girl had always thought that this had some significance, but she could never quite put her finger on it). The girl whose name, by some sarcastic twist of fate, was Hope, took it upon herself to ration out the food supplies that had been stockpiled in the cave prior to the war. She was also the "Protector of the Peace" for the group. 
At the start of her leadership role she had envisioned educating all 23 children in the basics of English, math, and science. During the first week seven children died because they ate some contaminated food. Hope decided that it was going to be difficult just to keep them alive. After a few months she also knew that it was going to be difficult keeping them civilized. 
At the age of 17 Hope realized that she was dying. It had taken awhile but the radiation was rapidly overtaking her body. 
As the teenage girl examined the world around her she became acutely aware that it wasn't a pleasant place to live in. Hope's main sorrow was not for herself, but for those she was leaving behind. They had to keep surviving. Hope knew that she had gone part of the way toward setting an example for the children to look for meaning, but she felt that something else had to be left behind. 
Under the old army cot on which Hope slept she had compiled a collection of about 20 volumes. Foremost among these books was a hard cover edition ofthe works of Shakespeare, six editions of Marvel Comics, and Man's Search for Meaning by Viktor Frankl. 
During her past year in the cave Hope had intended to read some of Shakespeare's plays, but she had never quite found the time. Besides the comics (which she had read through seven or eight times apiece) she had never really been able to sit down with any of the books. Until recently. She was lying on her bed, 
44 
pondering how she was going to prepare the young ones in her charge to survive after her death, when the title of the Frankl book finally struck her: Man's Search/or Meaning. 
Frankl had been a German Jew who had spent over 2½ years in the Nazi concentration camps. He was also a psychiatrist/ philosopher. He had combined his experiences with his education and genius for insights to create a powerful formula for living. Hope found Frankl's writing very applicable to her life because most of his focus was on spiritually transcending suffering. And Frankl had suffered. The girl appreciated his philosophies because they had endured the test of real life-they were not just words on thin air. 
There was one quote in Man's Search for Meaning that Hope found especially important. It was a passage that summed up Frankl's feelings about his experiences in the concentration camps. He asked, "Has all this suffering, this dying around us (the inmates in the death camp), a meaning? For, if not, then ultimately there is no meaning to survival; for a life whose meaning depends on such a happenstance-as whether or not one escapes (the camp)-ultimately would not be worth living at all." 
Hope loved the passage because she felt that it went to the very core oflife. To her it sang with simplicity and purity oftone that no religion had ever achieved. Frankl was idealistic, but she saw truth in·his message. 
Hope was also interested in the psychological aspect ofthe author's teachings. The death camp survivor was responsible for founding the school of Logotherapy. Logotherapy was Frankl's way of transferring his philosophies into a practical, therapeutic application. "Logos" turned out to be the Greek word for both "spirit" and "meaning." "Therapy" was self-explanatory. Hope saw the need for "spirit therapy" on her children. She had decided what to leave behind after she died. 
Hope had determined that meaning should be instilled into the human life at the earliest possible age. She wanted to put Frankl's message into a context where it would be remembered. She considered putting it on her tombstone, but dismissed the idea after recalling that she could not make a proper tombstone. Writing down the message had also occurred to her, but that was too riskysome of the little ones might use the paper with the quote for kindling. She finally decided upon putting the message in the form of a myth. This was the only way that she was guaranteed that the story would be passed down from generation to generation. 
The following myth was taught to the remaining children shortly before Hope died: Before there were stars in the universe there was the Creator. He had always existed. He was the beginning and the end. 
When the Creator made the Earth He fashioned the mountains, the sky, and the ocean first. When this was done He saw that all His works had order. Sky and ocean were balanced, as were the mountains, which lay between the heavens and the water. The Creator then set the world in motion, decreeing: "This order 
shall work its way toward disorder and, in doing so, shall find order again." 
This done, the Creator proceeded to form the creatures that were to populate 
His planet. He then waited for the newly born beings to approach Him and 
receive their missions for life on Earth. The crow came first, and then the coyote, 
45 
and so on, until all the animals except one had come forth. The Creator waited, but still the being did not come forth. Finally, in frustration, the Creator went forth and found the Human, who had been hiding in a far flung corner of the universe. "Why will you not go with the others to Earth?" questioned the Creator. "Because I am unprepared. I have no purpose," replied the Human. The Creator answered, "They had to come forth to receive their reasons for life. I see that you chose not to receive yours, therefore you have created your own purpose. Your job on Earth is to find meaning and order where there is only chaos. You must make justice where justice cannot be made, and cause love to flourish where only ignorance and hate can grow." 
This is how the Human Being came to be on the Earth. 
I wrote the preceding short short story to illustrate what I interpret as the main points of Viktor Frankl's philosophy. I hope these points are selfexplanatory. However, I would like to add a small footnote concerning one aspect ot my narrative. 
I believe in the eighties we are going to see a great amount ofsuffering, with or without a nuclear war. No age has ever been free from mishap, and I think that Frankl's writings apply to any human situation at any time (and perhaps to some nonhuman situations as well). After all, suffering is a purely individual affair. Frankl points this out when he writes, "Each man is questioned by life; and he can only answer to life by answering for his own life; to life he can only respond by being responsible." And so, with this note of explanation, I shall finish the story: 
Hope felt content for the first time in her 17 years. She knew that her myth would be perpetuated in the years to come. As she lay down for the last time on her cot she fingered through her worn copy of Mans Searchfor Meaning. Hope flipped absentmindedly to the front page of the book, and discovered a handwritten note she had previously overlooked. It was in her father's hand, "Dear Hope, I have found this very useful in my life. I know that it will be applicable in yours-no matter what fate hands you in the way of living conditions. Love, Dad." Hope read the passage, smiled, and then died. 
JEFFREY MITCHELL, agraduatefrom Yosemite Union High School,presently is attending Whitman College in Walla Walla, Washington. 

Alcoholic Recovery by Videotape 

James C. Crumbaugh 
For several years I have been giving three-week "crash courses" in the Alcoholism Treatment Unit of the Veterans Administration Center in Biloxi, Mississippi.1 The patients had been especially selected and were seen five days a week for one hour a day, using my book Logotherapy: New Help for Problem Drinkers as a text. 2 The patients read the book, and then we discussed each day the corresponding part, allowing time for them to interact and express their feelings about the topic at hand. The optimum number for the group were five to seven patients, though at times we would go up to 12 or drop to one. 
Although our experience had shown a closed-ended group to be most efficient, practical necessity had dictated open-ended groups because the treatment program had been shortened, and there was no opportunity for suitable patients to wait for a new starting group and finish it before discharging time. The experience of the patient in an open-ended group is similar to that of a person entering a movie theatre in the middle of a show: starting at the beginning is convenient but not necessary. To reduce the difficulty we gave each new patient an outline of the course as a summary preparation. The patient then picked up with us on whatever chapter he entered. Patients who completed the program and did certain exercises in the book were issued a Certificate of Attendance in the personal use of logotherapy. 
Upon my retirement from active hospital practice I have continued a logotherapy group in collaboration of my long-time assistant Rosemary Henrion. We reorganized the program to fit our time schedules, and it was necessary to fill gaps when neither of us could take the group. We decided to do this by the use of audio-visual equipment. Six video-taped lectures were prepared, ranging from 30 minutes to approximately one hour. They covered the entire text as follows: 
Lecture/: Motivation as the Key to Alcoholic Recovery, and Logotherapy as the Key to Motivation. This tape includes an introductory summary of the principles of logotherapy. 
Lecture II: Choosing your Life Style. Step One in Logotherapy, as the text presents it, is determining whether you are going to travel the material, reductionist route ofJean-Paul Sartre and the mechanists, or whether you see life in a teleological sense as having an intrinsic purpose. The mechanists must seek a personal meaning to superimpose upon a meaningless world, while the teleologists must search for what they believe to be their personal part in an intrinsically purposeful universe. But before those of either view will find a challenging life meaning, they must decide which of these two basic life styles (these are really Kierkegaard's "Either/ Or'') is to be followed in the search. 
Lecture Ill. Building Self-confidence and Creative Thinking. The second and third steps in logotherapy, according to the text. This tape presents exercises for developing self-confidence, expanding perceptual awareness of the world around us, and stimulating creative capacities in the perception of new meanings. The clients must first believe they can do it, and then begin the developmental process. 
Lecture IV. Encounter. The fourth step in applied logotherapy, according to this text, is learning to establish encounters, which are considered the key to finding genuine meaning. Thus real meaning is found not in material things, but in relationships. This tape presents exercises in developing the ability to establish encounters on one or more of three possible levels: Sub-human (animals, pets); human; and super-human (a Higher Power). 
Lecture V. Dereflect ion. The fifth and final step in finding meaning, as viewed by this text, is the core activity ofexploring all avenues ofclients' experience and of the possible new channels open to them for possible new goals and goaloriented activities that may furnish genuine meaning within the framework of their chosen life style. The real source of actual meaning will always be some relationship or encounter which yields a feed-back of appreciation, approval, response ( of "love" in at least one of the six Greek senses). 
To establish this relationship (which may actually be either real or imagined, but which will seem real to the individual and thus will be phenomenologically valid), one must do something-even if it is only petting a dog. Some activity must be found that gives meaning through fulfilling some personal value; and that value will have been created only by some type of encounter, real or imagined, now or even in the future. 
This fifth tape examines methods ofexploring the world ofexperience for the right activities for the particular person. To do this, the client's attention is deflected from past failures and incapacitating factors (from rationalizations for not trying) to remaining assets and capabilities, which can lead to discovery of genuinely meaningful new goals. 
Lecture VI. Commitment. This final topic is not conceived by the text as a step in logotherapy, but rather as the result of applying the preceding five steps. If they have not resulted in commitment to clear and strongly motivating goals, the steps have not been successfully applied. This final (relatively short) tape makes these points, and shows the individual how to determine the level of success which has been achieved, and-if necessary-how to go about repeating the steps. 
Only few clients find a whole new life purpose and meaning in a three-week crash program (although occasionally we have seen it apparently happen), but our hope has been to teach them the principles and methods by which the job may be successfully pursued and completed at home. While follow-up has been inadequate (as is true of the vast majority of hospital programs), clients who come back or write back after months, or even years, furnish evidence that the work has helped many, and some in vital ways. 
We found that the program still was effective when the teaching was done wholly or partly by tape, provided some staff member stayed with the group through the tape. Otherwise some patients would cease to pay attention and would distract the others. 
48 
The most effective procedure has been the presentation of a tape at one session, followed by group discussion of this tape at the next session. We have alternated as therapists ofthe group, though sometimes it has been necessary for one therapist to take two sessions in sequence. 
Multiple therapists present both advantages and disadvantages. On the positive side is client exposure to more than one point of view and manner of presentation. Negative features are some unavoidable discontinuity, and the fact that clients will sometimes try to manipulate the therapy by playing one therapist against the other. 
Our experience indicates that logotherapy can be successfully conducted by incorporating the use of video-tape and other audio-visual aids, though it will lose effectiveness when presented only on tape. This is probably true for all therapies, but we do believe that more usage can be made of audio-visual techniques in conducting logotherapy than has so far been presented in the literature. This is a field to be explored further in the near future. 
JAMES C. CRUMBA UGH, Ph.D., is a certified practicing logotherapist in Gulfport, Mississippi, and Regional Director ofLogotherapy Chapters in the Southeast. 
REFERENCES 
l. Crumbaugh, James. "Logotherapy: New Help for Problem Drinkers," in the International Forum for Logotherapy, 1981, 4(1), 29-34. 
2. ___ Wood, W. M. and Wood W. C. Logotherapy: New Help for Problem Drinkers. Chicago, Nelson-Hall, 1980. 
49 

Takashima's 
Noo-Psychosomatic 
Medicine 
Paul Naitoh 
Takashima's personal convictions as a logotherapist could be expressed by his statements: 
Medicine without science is powerless. Medicine without philosophy is meaningless. Medicine without humanity is soulless. 
Noo-psychosomatic therapy considers patients in their fullness as human beings. First an extensive physical examination is given to them to confirm that their major complaints are truly "psychosomatic." This step is considered crucial because often small undetected somatic lesions, such as early-stage bleeding ulcers in the small intestine, add to the debility ofa psychosomatic disease. These somatic lesions are dealt with before logotherapy is applied to the psychsomatic disease. Thus, scientific knowledge is crucial for noo-psychosomatic medicine. 
However, Takashima argues that medicine is not all science. Many diseases are not well understood in present scientific medicine. Referrals from internalmedicine and surgery departments revealed to Takashima that some patients were physically healthy, in spite oftheir intense suffering. At the other extreme, scientific medicine could detect terminally ill cases, but was not able to manage these patients humanistically and satisfactorily. 
With noo-psychosomatic medicine based on logotherapy, Takashima offers medical professionals an opportunity to manage even those who are afflicted with terminal and incurable diseases. 
One hallmark of noo-psychosomatic medicine is the doctor's willingness to spend more time with patients talking about their sufferings than is usually possible in daily clinical consultations. Noo-psychosomatic medicine requires an intense interaction with patients. Contrary to psychoanalysis, however, the patients are persuaded to talk about something they did not wish to talk about, whereas in logotherapy they are persuaded to listen to things they did not wish to 
hear. 1, P-152 
During a Jogotherapeutic dialogue patients are motivated to change their attitudes toward their diseases by mobilizing their psychonoetic antagonism: Patients may get angry at the therapist and at themselves after hearing repeatedly what they did not wish to hear. This anger helps to break the vicious cycle which had trapped them in unwanted behavior patterns. 
50 
Living with Disease 
One method Takashima uses in treating unwarranted anxiety stemming from such psychosomatic diseases as stomach ulcers, pancreatitis, colitis, bronchial 
, P-33
asthma, rheumatism and others, is what he calls "living with disease. "3 
A patient, attacked by a disease, often will instinctively fight to get rid of it. "Fighting against disease" is a must for winning against diseases that can be conquered, but the matter is different when the patient fights against chronic degenerative diseases such as arteriosclerosis or chronic rheumatoid arthritis. In fighting against these incurable diseases, patients will run from one specialist to another. Takashima cites the case of Mr. M, age 73. When he was 60, he began to feel pain in both knees which was diagnosed as a mild form of chronic rheumatism. For two years he tried various remedies without any relief. In desperation, he sought help from Takashima who recommended a medication to relieve the pain, and told Mr. M to accept and "live with" his rheumatism, without exhausting himself searching for a nonexisting cure. After accepting Takashima's advice, Mr. M nowadays regards his "little old knees" like old friends. He told himself to be "kind"to his knees from now on because he had been a burden on them for 70 years. 
Another example of "living with disease" is the case of Mr. T, a 37-year-old professor, who was told six years ago that his sufferings came from hypertension. After a dismal struggle with hypertension, he sought Takashima's advice. Mr. T's hypertension was diagnosed to be at an early stage and quite manageable. He was healthy in all other aspects. His sufferings were caused more by his dread of the disease and from his emotional exhaustion from fighting against it, and was told to drop his exaggerated fear and to come to terms with the disease. Takashima discontinued the medication, provided that Mr. T would reduce weight and take sufficient rest when tired. Two years later, Mr. Twas found to "live with hypertension," and his blood pressure was on the low side, without medication. He was in good shape both physically and mentally. 
When should a patient fight against a disease, and when should he stop fighting and simply live with the disease? Takashima tells his patients the story of "a snake and an ox." If you are placed in a room with a small poisonous snake, you should fight to kill it. This also is the proper attitude toward a disease that can be overcome. But if you are sharing your room with an ox, a gentle but powerful animal, the proper attitude is to tame and not try to overpower it. Similarly, you should try to live with a disease which cannot yet be overpowered by medical science. Takashima himself provides an example: He has been living for 30 years with only one lung (the other lung together with several rib bones were surgically removed). A recommendation whether a patient is to fight against or live with a disease should come from the doctor's scientific knowledge about the odds of a cure, but the patient's willingness to follow the doctor's recommendation plays a critical role in its success. 
The case of Mr. Jun Takami, a well known writer in Japan, provides an 
example of how much can be achieved by "living with disease. "3, P-37 Takami 
underwent an operation for cancer of the gullet in 1963. It recurred and he died 
two years later. During those two years he underwent four operations. His 
condition became critical five times, but he survived all these crises. He died 
shortly after learning that his lifelong project, the founding of a Modern 
51 
Literature Museum, had progressed far enough to hold the ground-breaking ceremony. During his last two years he "lived with" cancer, devoting himself to his life work of founding the Modern Literature Museum. The courage to live with cancer had come from his "defiant power" of the human spirit which, 
, P-39
according to Frankl, can have a life-prolonging, even a life-saving, effect. 3 
The richness of case histories has made Takashima's noo-psychosomatic medicine attractive to mental health professionals as well as to laypersons. It may still lack the theoretical foundation and systematized doctrines, but the case histories have shown sudden and enduring changes in the patients' attitudes and value systems. Perhaps future research in clinical psychotherapy will identify Takashima's skill in treating disease and promoting healthy attitudes of mind. 
Besides the "living-with-disease" concept, Takashima applies his logotherapeutic skill in treating noogenic neuroses. The following case is taken from Takashima's 1981 lecture in Australia where he was asked by Dr. C. W. to treat one of his patients. 
A Case of Noogenic Neurosis 
Mrs. W, age 50, has two children. Her third child died at the age of 17. 
Past medical history: Intermittent vertigo, back pain, neck pain, headache, abdominal pain. In 1977, the abdominal pain was so severe that it resulted in a laparotomy. However, no abnormality was found, and she was thought to have a very low pain threshold. 
Present psychological problems: Constant depression and anxiety, which have continued for many years with little change despite medical treatment, with tofranil and triptanol, and also psychotherapy. She has been labeled as having a "neurotic hysterical personality disorder." 
The patient feels that the greatest task in her life was caring for her daughter who was born with a congenital heart defect and suffered from hemiparesis. Mrs. W had devoted all her care and attention to this child, at the cost of any close relationship with others, including her husband. She feels her daughter was the only one who ever loved and really needed her. 
After a second heart operation the girl developed hepatitis. Mrs. W was away on a vacation when the girl became seriously ill, and came back shortly before the girl's death. This had been the first time she had ever left her daughter, and still blames herself for not having given her more love and attention. 
After the death of her daughter, Mrs. W saw no further reason for living and took an overdose oftablets. She was in the hospital for some time. She found no support in her husband who had begun to drink heavily. 
Mrs. W was unable to sleep and was in a deep depression. She frequently saw her psychiatrist, as well as her local general practitioner, Dr. C. W. 
Mrs. W refused hospital admission stating that "you only have to pretend you're better so they will let you out again." Her psychiatrist increased her tablets which have helped her to sleep. However, she is still extremely tearful and depressed. 
Takashima saw the patient in the presence of her husband, two doctors, and two counselors. 
Takashima: Ifyour daughter were still living, who would be the one to suffer? Mrs. W: My daughter. 
T: You still love her, don't you? 
52 
W: Yes, very deeply. 
T: Would you be willing to suffer instead of her, if she were living? 
W: 
Naturally, I should suffer willingly. 

W: 
But she is dead now and relieved of her suffering. So that, if someone must suffer, you can suffer instead of her. Now, let me use an example. Suppose that suffering is like water. You are now drowning in water, and you are trying to save yourself even though you know this is impossible. Right? 

W: 
I just can't. 


T: In the water of suffering, you can swim instead of drowning, can't you? 
W: Yes, I think so. 
T: Perhaps you can even swim beautifully. 
W: (after a pause) Yes, I can try. 
Takashima added: "Through such conversations, Mrs. W realized that the suffering has meaning in her situation, and she accepted the suffering which symbolized water (of tears). 
She was drowning in the water, but now she is swimming, even trying to swim beautifully. Thus, she changed her attitude -she showed a positive attitude, suffering willingly, after struggling with suffering for many years. And she and her husband were holding hands. It happened in only one hour. 
It was she who cured herself, not I. When nothing could be changed except her attitude, she did it by her own wisdom, meaning orientation and free decision, and she cured herself. I just helped to make her aware of her wisdom. 
Some people are amazed that she, a "not highly educated" woman, found the meaning even in suffering. Perhaps she did not have much knowledge, but wisdom is different from knowledge. Wisdom comes from having humaneness in one's heart. 
Critical Evaluation of Noo-psychosomatic Medicine 
Takashima's noo-psychosomatic medicine has aroused much interest in Japan, judging from the many requests for his lectures and his articles and books. However, a logotherapy organization in Japan, managed by Takashima, has a small membership of about forty, and none of them are practicing physicians. This lack ofsupport from the Japanese medical profession may have several reasons. 
One reason may be Japan's National Health Service Plan which does not 
recognize the time-saving aspects of logotherapy, and does not yet accept 
logotherapy as qualifying for monetary compensation. 
However, the main reason inhibiting acceptance of logotherapy or noo
psychosomatic medicine by the Japanese medical professionals could be the 
doctors' antagonism toward Takashima's insistence that "medicine without 
philosophy is meaningless," and "medicine without humanity is soulless. "3, P-39 
To most medical doctors, trained in the science of medicine, noo-psychosomatic 
medicine sounds like a new religion. 
Takashima has been aware of this misunderstanding and been careful to keep 
his language direct and concrete. However, when discussing the human craving 
for meanings and values, and our anxiety about becoming increasingly insigni
ficant and interchangeable in modern society, he cannot easily avoid such 
abstruse concepts as "noogenic neuroses" and "existential vacuum." 
53 
Takashima incorporates philosophy into medicine to bring humanness back into medicine. He does not explicitly define what he means by philosophy, but his writings suggest that to him it means a study of human nature. Certainly he does not mean metaphysics of mind-body problems, and epistemology to explore the theory of knowledge. However strong an aversion one might feel toward Takashima's "philosophy," one cannot deny the efficacy oflogotherapy and noo-psychosomatic medicine in treating or managing certain diseases. 
Takashima incorporates philosophy into medicine to bring humanness back into medicine. He does not explicitly define what he means by philosophy, but his writings suggest that to him it means a study of human nature. Certainly he does not mean metaphysics of mind-body problems, and epistemology to explore the theory of knowledge. However strong an aversion one might feel toward Takashima's "philosophy," one cannot deny the efficacy oflogotherapy and noo-psychosomatic medicine in treating or managing certain diseases. 
Logotherapy and noo-psychosomatic medicine has been criticized by behavioral and experimental psychologists. They feel that logotherapy represents an undesirable reverting to philosophy and religion from which psychology won its independence. But, as Takashima has pointed out, logotherapy and noopsychosomatic medicine do not "regress" into religious questions ofthe purpose of life. In religion the purpose in life is given by God, whereas in logotherapy it is searched for and found by the patients. Logotherapy does not dictate what the purpose in life should be. If patients happen to find their purpose to be of "religious" nature, then this is acceptable. But logotherapy and noo-psychosomatic medicine do not recommend religion, and even less one religious belief over others. A line of demarcation between logotherapy and religion has been drawn clearly by Frankl. 2 Buddhism has influenced Takashima's outlook on the world considerably, yet Buddhism is accepted only as far as it provides for him a view ofhumanity. The success of noo-psychosomatic medicine does not depend on faith in Buddhism. 
As mentioned previously, the greatest asset of Takashima's noo-psychosomatic medicine lies in the vast number of case histories. Each case confirms the validity of his view in treating patients. His therapy appears successful especially among those who are neither healthy nor really sick, but simply aged, often with incurable degenerative diseases. 
Although many case histories from Takashima's files have appeared in books and his newspaper columns, a vast number of them remain unsystematized and unpublished. 
So far, no video-or film-recordings of Takashima's interactions with the patients have been made in Japan. Such recordings would be useful in understanding the processes ofpsychotherapy as used in noo-psychosomatic medicine. 
PA UL NA/TOH is research psychologist at the Applied Psychophysiology Group, San Diego, California. 
REFERENCES 
I. Frankl, V. E. Man's Search/or Meaning: An Introduction to Logotherapy. New York, Pocket Books, 1963. 
2. Psychotherapy and Existentialism. New York, A Touchstone Book, Simon and Schuster, 1967. 
3. Takashima, H. Psychosomatic Medicine and Logotherapy: Health through Noo-Aychosomatic Medicine. Oceanside, N. Y. Dabor Science Publications, 1977. 
54 
PIL Test on Cancer Patients 
Preliminary Report 
Rosemary Henrlon 
Recent statistics indicate that one out ofevery three individuals in the United States will have cancer in his or her lifetime. The term .. cancer" still carries a stigma in our society, and in the eight years that I have been therapist this theme periodically predominates the group sessions. The families as well as the patients are concerned with how the cancer patient is seen by others, especially if the patient is being discharged from the hospital or domiciliary to the community. Another concern ofcancer patients is their fear of dying without any chance for recovery or of accomplishing the goals they have set for themselves. Positive attitudes are vitally significant to these individuals, and they have a definite need to continue to have personal meaning in their lives. Frankl4-5 maintains that individuals can have purpose and meaning in their lives to the last breath. We helping professionals can make this goal a reality by assisting the patients to continue or reorder their priorities and control the directions in which they wish to take their lives until death or until they are no longer physically, emotionally, and mentally capable of the responsibility. 
Procedure 
The theoretical framework I use with cancer patients and their families is the integration of Kubler-Ross'6 approach to death and dying in which a baseline is established as to the stage the individual is experiencing. Catharsis, or utilizing a therapeutic process to elicit catharsis, may be accomplished; and then positive attitudes are interjected to assist the individual to find a new meaning. However, some patients are unable to develop their personal meanings. In my experience patients who can utilize this process achieve greater satisfaction toward planning their lives. The patients have said, "I feel good knowing that I can be productive even with my having some physical limitations." In addition, their nonverbal communication, i.e., walking erect, head high, is congruent with their positive verbal communication. These individuals also become aware that someone genuinely cares about them as human beings which helps them realize deeper, meaningful relationships with others. Another logotherapeutic principle (the attitudinal value) asserts that while the situation is deplorable and sometimes unchangeable, individuals can continue to have a purpose and meaning in their lives. Through suffering they can develop meaning because, although they cannot change their situation, they can change themselves. 
55 
Clinical Evaluation 
The Biloxi Veterans Administration Medical Center has approximately a 1,000-bed capacity, which includes the general medical-surgical division, psychiatric division, and the domiciliary. The domiciliary is one of three settings in which cancer discussion groups are held weekly for one hour. The meetings are held in a private area, to avoid disturbances. 
The group in which the PIL test was applied consisted of 18 males, ages 50 through 75 years, with an average mean of64. 3 years. These patients come from a four-state area-Louisiana, Mississippi, Alabama and northern Florida. 
Ten out of the 18 patients agreed to take the Purpose in Life Test.2 Their cancer was in remission and they were having no ill effects from the disease. The diagnoses for these patients covered cancer in the following areas: (I) tongue, (2) skin, (3) lung, (4) lower intestines, (5) stomach, (6) ear, and 
(7) sinus. 
Interpretation of Data 
An item analysis of the twenty questions revealed that the scores were bimodally distributed. In Statement I, five patients reported being usually enthusiastic, and two felt completely bored. In Statement 2, six saw life as always exciting, two said life was completely routine. In Statement 3, five felt their goals and aims were very clear cut, two saw no goals or aims at all. In Statement 4, six felt their personal existence was very purposeful and meaningful, while three found it utterly meaningless and without purpose. The first four answers showed that the respondents' survival and security needs were being met while living in the domiciliary. These met needs are congruent with the first and third levels of Maslow's hierarchy of motivational needs.7 One-half to two-thirds ofthe patients felt their personal existence had meaning and purpose while the rest had not progressed to this point in their lives. 
In answer to Statement 5, six respondents said every day was the same, a strong negative response, and only two felt that every day was constantly new. More than one-half of the subjects had not changed their attitudes in accepting each day as challenging. The schedule ofdaily activities is posted in the domiciliary, and it is the responsibility ofeach member to participate in these activities. Patients in this age group may be less motivated to get involved in groups and prefer to remain by themselves or with a friend. 
In the sixth statement the responses were equally weighted in the neutral and positive upper limits in choosing "nine more lives just like this one." Only one person stated he preferred to have never been born. This man also had a history of emotional problems. 
Five subjects in the seventh Statement said they would do some ofthe exciting things they had always wanted to do while three were neutral in their feelings. Again, attitudes play an important role in assisting individuals to develop hope for a meaningful future. 
56 
Five persons answered Statement 8 by stating that they had not made any progress whatsoever in achieving their goals in life, and only two said they had progressed to complete fulfillment. Erikson3 suggests that people during their years of generativity and senescence are primarily reflective of their accomplishments versus their failures during their lifetime. 
Only three subjects in Question 9 felt their lives were running over with good things, while one felt his life was empty and filled with despair; four remained neutral. Those individuals who did not score in the upper positive limits in the eighth Statement may have been influenced to respond to Statement 9 in this manner. 
In Statement 10 five said that if they should die today they would feel their lives had been very worthwhile. It seems that these respondents had achieved inner peace, and were prepared to go on with whatever life held for them. 
Statements 11, 14, and 18 are bimodally distributed, and are weighted in a positive direction. The statements allude respectively to always seeing a reason for existence, to being absolutely free to make choices, and to being in control of their lives. These patients seemed to have developed definite purpose and meanings and excellent control in their lives. 
Four respondents in Statement 12 viewed the world as fitting meaningfully into their lives, while two felt completely confused. The theme of one of the cancer group sessions dealt with cultural changes in our society and their effects on individuals. One patient said, "With all the happenings in the world today, I don't know where we all will end up, do you?" 
Five patients declared in Statement 13 that they felt they were irresponsible, while the other five felt they were very responsible people. One ofthe criteria for being accepted into the domiciliary is that the patient does not have a home in the community, or is unable to live outside the domiciliary for legitimate reasons. Half of the subjects seemed to have made the adjustment living in the domiciliary. 
Seven respondents in Statement 15 stated they were prepared and unafraid to die. This response indicates that they had accepted their illnesses and were also experiencing inner peace. 
Statement 16 revealed that seven persons never had given suicide a second thought. In Statement 17, seven subjects stated they had great ability to find a meaning, purpose, or mission in life. 
Reading the above three items helped me to reflect on some of the group meetings. The majority ofthe members'nonverbal communication conveyed, "I am taking life as it comes each day, and I go about my day doing what is essential, including socialization with others as well as some recreational activities." 
Statement 19 may be taken one step further, because it is almost equally weighted at the upper positive and lower negative limits of the scale. Three respondents said facing their daily tasks was a painful and boring experience, while four found the same experience a source of pleasure and satisfaction. 
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Those individuals who felt they had made no progress and who experienced despair earlier in the test may also have answered in the lower negative end ofthe scale. 
Statement 20 indicated that six respondents had discovered clear-cut goals and satisfying life goals. Much of the stress has been reduced for the veteran by his opting to live in the domiciliary. The attitudes of these men may have well been different had they returned to the community and been totally responsible for themselves. 
According to Crumbaugh and Maholick's PIL instruction manual, 40 per cent of the "regular" hospital patients scored in range from 72nd through 97th percentile (l 13-I36), which indicates the presence of a definite purpose and meaning in life; while 60 per cent scored from zero through the 28th percentile (43-91). These scores demonstrate a lack of clear meaning and purpose. We found that in our group of cancer patients the purpose and meaning in life was lower than in "regular" hospital patients (M=90.30), but not as severely as those hospitalized patients with alcoholism (M=85. 7) and non-schizophrenic psychotics (M=80.50). Schizophrenic patients (M=l08 for hospitalized blacks and M=96.66 for hospitalized whites) scored unusually high for patient populations; and this finding (since many schizophrenics are paranoid) agrees with Frankl's conclusion that paranoid patients have a tendency to see a "deeper meaning" even behind the most trivial events. 2 Consequently, our preliminary findings indicate that patients with cancer may have more meaning and purpose in their lives than schizophrenics though without their paranoid ideation. 
Conclusion 
Patients who experience catastrophic illnesses such as cancer need to have a definite purpose and meaning to continue as worthwhile individuals and maintain a status with human dignity until death. Persons who have become sick frequently regress through loss in self-esteem, security, and love needs. Their survival needs may suffer even more if they are so unfortunate as to be financially ruined because of exorbitant medical fees. In my experience, cancer patients and their families who have depleted their life's savings suffer undue additional stress. 
The integration of Kubler-Ross' five stages of grief and Frankl's logotherapeutic principles complement each other's approach. The PIL test and Meaning in Life Evaluation Scale1are additional tools which are valuable in establishing a baseline with cancer patients or assisting them to continue to find meaning although they are suffering. The test points to the patients who need additional help and to the areas where the help is needed. The therapist will elicit group support for such patients and work with them individually. 
Although this population sample of cancer patients was small, the results are encouraging. Little if any research has been done in this area. It is my goal to initiate formal research with cancer patients when adequate space and funds become feasible. The patients are a challenge, and, because of my experience 
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with them, my life is much richer than it would have been had I not had this opportunity. In essence, I have found and am continuing to find a deeper meaning in my life through this work. 
ROSEMARY HENRION, MSN, M. Ed., RN, is psychiatric clinical nurse specialist in the Veterans Administration Medical Center, Ciloxi, Mississippi. 
REFERENCES 
I. Crumbaugh, James C. Logotherapy: New Help for Problem Drinkers. Chicago, Nelson-Hall Company, 1980. 
2. 
___and L. T. Maholick. KPurpose in Life Test. H Munster, Indiana, Psychometric Affiliates, 1969, 1976. 

3. 
Erikson, Erik. Childhood and Society. 2nd ed. New York, W.W. Horton, 1963. 

4. 
Frankl, Viktor E. Man's Search/or Meaning. New York, Pocket Books, 1977. 

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

6. 
Kubler-Ross, Elisabeth. Death and Dying. New York, Macmillan Publishing Company, 1969. 

7. 
Maslow, Abraham H. Motivation and Personality. New York, Harper and Row, 1970. 


A PERSONAL CREDO 
I believe each person is a unique being -unique in thoughts, feelings, and needs. I believe each one is possessed offree thoughts andfree choices, doing what is in their power to do by their nature, choice, and will. I believe I can better understand others, iffirst I better understand myself. Insomuch as free will andfree reasoning have been granted to me, it becomes my fundamental obligation to choose between good and evil, to determine and be responsible for my own deeds and ethical conduct. I believe my life will have more meaning ifI do not livefor myselfonly; unconditionally, people are more important than things. If at the moment I do my very best, then that is all I or anyone can ask ofme. I believe that dying is my last act while alive, I would like to do it with dignity and with loved ones by my side. 
Edward Lazar . 
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The International Forum for 
LOGOTHERAPY 
JOURNAL OF SEARCH FOR MEANING