Therapeutic techniques of logotherapy

Introduction

1. The relationship between the counsellor and the client is the key to success in logotherapy
2. The basic assumption is trust in the spiritual core and the defiant human spirit of the client
3. The overarching concept is the optimistic view that meaning can be discovered in the worst of circumstances and that a meaningful future can be built from the rubbles of the past
4. Therapeutic techniques are only secondary to the above fundamentals
5. Which interventions to use depends on the individuality of the client and the specific situation of each case

Therapeutic relationships

1. View treatment as a joint venture directed towards discovering and fulfilling meaning
2. As a human being, share the essential human concerns – therapist and client are more similar than different at the deepest level of humanness
3. As a psychotherapist, provide diagnosis and treatment
4. As a logotherapist or meaning-centered counsellor, understand the clients’ existential distress and facilitate the discovery of meaning
5. Practice authentic communication – being genuine, open, direct, confronting and yet validating and encouraging
6. Counsellors need to have developed their own value-systems
7. Counsellors are willing to change as a result of interactions with their clients
8. Model tragic optimism and meaningful living

Self-distancing

1. This is the first step in logotherapy
2. The human capacity to separate the client from his or her problems
3. Help clients see that they are not helpless victims
4. Awaken the defiant human spirit to see that one can overcome the problem or symptom which is not an integral part of one’s being
5. Able to detach oneself and see the problems from the outside and look at the situation with a sense of humor
6. Able to laugh at oneself and at the symptoms
7. Self-detachment is important especially for short-term therapy

Paradoxical intention (PI)

What is PI?

1. “The only thing we fear is fear itself”
2. PI is designed to treat fear of fears or anticipatory anxiety
3. Fear of fear is typically related to three response patterns:
   (a) Flight from fear – phobia patterns of avoidance behaviour
   (b) Fight against obsessions – fear that obsessions may become psychosis
   (c) Fight for something – sexual neurotics
4. Make use of the human capacity for self-distancing – they are not their fears
5. It is paradoxical, because the client is encouraged to intend or wish what one fears most
6. It is a non-specific technique effective for short-term therapy

How does PI work?

1. PI is effective with various kinds of phobia and obsessive-compulsive disorders
2. The main objective of PI is to reduce the anticipatory anxiety and break the vicious cycle
3. Anticipatory anxiety can be reduced through self-distancing, humor and the defiant human spirit
4. Clients are asked to say or do something grossly exaggerated to the point of being ridiculous
5. Sometimes persuasion or appeal technique is used before the application of PI
6. Something may happen at a deeper level – restoring a basic trust in one’s spiritual core and one’s human capacity for detachment
7. PI should not be applied in psychotic depression, except in cases where the patient is haunted by the obsessive idea that he might commit suicide. The question: “Why not” usually serves to reawaken the client’s sense of responsibility
8. How does MCC practice PI?
   – Acceptance – Accept the fact that one has a problem with phobia or obsessive-compulsive disorder
   – Belief – Believe that person is not the problem and that the person can overcome the problem
   – Commitment – Commit oneself to the practice of (a) approaching and confronting one’s worse fear (even for a brief moment) and (b) exaggerating one’s worst fear. The very action of approaching not only counteracts the tendency of avoidance but also receives reinforcement by debunking the myth of fear
   – Discovery – Discover that the action of confrontation did not result in a disaster and in fact the dreaded symptom actually disappears

Dereflection

What is it?

1. Designed to counteract the compulsion to self-observation or hyper-reflection, such as worrying oneself to death about one’s body image or sexual performance
2. Through PI, the client learns to ridicule his symptoms; through dereflection, the clients learns to ignore the symptoms in order to focus on the task at hand
3. Based on one’s capacity for self-transcendence and will to meaning
4. We are able not only to detach ourselves from our conditions, but attach to something or someone beyond ourselves
5. By immersing ourselves in creative or experiential values, we are able to transcend our conditions

How to do it?

1. A two-step procedure. First, stop the obsessing of hyper-reflection about the problem. Second, switch to something positive and meaningful
2. Shattering of the assumptive world creates potentials for new meaning in life
3. In order to forget oneself, one must learn to give of oneself for the sake of something or someone other than oneself
4. Dereflection is effective only to the extent that one is able to switch focus to some positive aspects of life
5. “The patient must be reoriented towards his specific vocation and mission in life. In other words, he must be confronted with the logos of his existence.” (p.258)
6. Dereflection has been effectively used in the treatment of addiction, chronic pain, burnout, insomnia and sexual dysfunctioning

The MCC approach to dereflection

1. Accept the fact that one is worried sick about some problem and is unable to resolve it
2. Believe that it is alright just to put the problem aside in order to focus on something more meaningful
3. Commit oneself to pursuing something meaningful and purposeful
4. Discover that the original problem fades away in the joy of positive living

This is similar to Morita therapy. Patients are taught and empowered to pursue what is meaningful in spite of feelings of anxiety or depression.

The PURE model will be employed in helping clients pursue what is meaningful and purposeful.

When we combine ABCD and PURE, we can achieve positive results in most cases.

Modification of attitudes

1. This method is particularly important in situations where only attitudinal values are available to the client
2. Modification of attitudes is needed when people suffer from fatalism, fanaticism, collectivistic thinking and living for the present only
3. Despair and depression can be overcome by developing an attitude of tragic optimism
4. First step is to recognize that we have the freedom of attitudes, which are determined by us rather than by situations
5. The second step is to recognize the importance of having a positive attitude towards meaning to fulfill
6. Needs to strike a balance between past accomplishments and future possibilities
7. We can modify unhealthy or negative attitudes towards the past, present and future

The appealing technique

1. This technique is helpful when the clients are too weak or too far out to respond to talk therapy
2. The counsellor communicates trust and appeals to the client’s sense of dignity, responsibility and meaning-orientation, regardless of his/her current physical, mental or emotional conditions
3. In the case of drug addiction before detoxification, it is not possible to do much talk therapy except to appeal to them to get help and to make them aware of the prospect of recovery
4. Appeal to their defiant human spirit by reframing the excuse “because my parents were abusive” to affirmation “although my parents were abusive…”
5. This technique is similar to persuasion designed to overcome client’s initial resistance

Socratic dialogue

1. Help clients discover themselves and meanings through Socratic discourse, which includes the counsellor’s Socratic questioning and the client’s response to it
2. Self-discovery consists of seeing behind the masks what is authentic and genuine in the person
3. Draw out from clients what they already know intuitively
4. Socratic questions help clients discover their freedoms and responsibilities to life’s demands
5. The assumption is that deep inside our spiritual core, we know what is meaningful and what we are meant to be
6. Not an intellectual discussion — Logos is deeper than logic
7. It is based on one’s life experiences
8. It helps clients to be in touch with their healthy spiritual core
9. Use open-ended questions to help clients confront with the demands of meaning
10. Paul Welter (1987) points out that Socratic questions are “two-legged” in order to stretch the thinking and horizon of the client
11. “The question needs to stand with one leg firmly in the client’s way of looking at her world, and the other in the new territory” (Welter, 1987, p.69)
12. This is similar to Wong’s double-vision technique with one eye on the immediate problem and another eye on the large picture
13. Socratic questions can be employed to address problems from the past, present and anticipated future
14. Socratic questions can be used to address a variety of issues (See Wong’s Brief Manual)

Examples of Socratic questioning (Paul Welter, 1995)

1. As you look back on your life, what are the moments when you were most yourself?
2. How do you find courage?
3. What are the most important things you have learned in life, what would they be?
4. What is something you’d like to celebrate?
5. What is life asking of you at this time, even in all your suffering?
6. When do you feel the most renewed?

Examples of Socratic questioning (Joseph Fabry, 1979)

1. Looking back, has anything positive come from those situations? Have you learned something from those? Grown?
2. What are the few things you want to accomplish during the next year?
3. Who are your role models?
4. What are your strong points? Your talents?
5. What are the obstacles to realizing them? How can you overcome these obstacles?