The development of psychotherapeutic approaches is based on the necessity of searching for relevant answers in the face of the challenges that life raises for us. In recent years, we have faced many such challenges. It started with the COVID-19 lockdown, when many important usual contexts were lost all of a sudden. Unusual conditions required special attention to mental health, and without fully resolved consequences, the war in Ukraine began. When the first Ukrainian refugee was about to come see me for consultation, I asked myself how I could consult him or her if I had no relevant experience or approach to what the patient was going through. How could I help the person facing unavoidable suffering that flooded him personally, as well as millions of people in Ukraine and war refugees in neighbouring countries? What is the relevant therapeutic answer to their sufferings? Everything I knew seemed not enough.
In response to these life challenges, my long-existing interest in the teaching of Viktor Frankl and his logotherapy methods started to resonate within me. This therapeutic approach was developed before World War II, but it seems worth recalling and revising in light of the current context.
Viktor Frankl, a psychiatrist and neurologist, was first a student of Freud and later belonged to the Adlerian school. Yet, he separated from both of them because of his belief that the deepest motivation of human actions is the will to meaning, instead of the strive for pleasure, as Freud stated, or the will to power, as Adler believed (otherwise, what is the motivation for risking your life in the sake of another person?).
Viktor Frankl viewed humans as tridimensional beings consisting of physical, mental, and spiritual levels, where spiritual does not necessarily mean religious. The spiritual dimension, according to Viktor Frankl, is responsible for the will to meaning. The word "Logos" comes from Greek and refers to meaning. Meaning is something unquestionable and inherent in life itself. It cannot be created; it must be searched for and found. Meaning differs from person to person and even from moment to moment. Searching and finding meaning is every person's responsibility. It is our response to the question our life raises before us every single moment. Free will and responsibility remain even in situations where external circumstances cannot be changed - in situations of unavoidable suffering. In these situations, at least we can choose our attitude to the situation. As Friedrich Nietzsche said, ‘He who has a 'why' can bear any 'how.'’
Viktor Frankl's book ‘Man's Search for Meaning,’ which I ran into 20 years ago and that impressed me so deeply, is considered one of the ten most influential books of the 20th century. In this book, one can find out how Frankl's theory of meaning, created before World War II, was tested by the most horrible human experience of the Holocaust. This experience reassured Frankl that the will to meaning is the most important motivational power. This is a factor that really mattered in surviving seemingly impossible circumstances. Two prisoners in a concentration camp, while speaking of their suicidal intentions to Frankl without knowing about each other, told him that they did not want to live because they had nothing to expect from life. Then a Copernican shift happened, and the vector changed its direction. The question actually was what life could still expect from a person. The prisoners discovered the meaning their lives still contained. After that shift, the mental state of the prisoners changed to the better radically, they were no longer suicidal.
Logotherapy is based on the premise that the primary motivation in human beings is the search for meaning in life, and that this search is what makes life worth living. According to Frankl, meaning can be found in three ways: by creating a work or doing a deed; by experiencing something or encountering someone; and by the attitude we take towards unavoidable suffering.
The meaning is always directed to the future and outwards, which is an important difference from other kinds of therapy that are often directed to one's childhood, to the past, and inwards. Meaning according to Viktor Frankl can be realized through experiential, creational, and attitudinal values. In logotherapy, the psychotherapist is seen as a "fellow traveller" on a journey towards personal growth and self-actualization.
The most known interventions that Frankl developed as part of logotherapy include paradoxical intention, dereflection and Socratic dialogue. Paradoxical intention involves intentional engaging in the behaviour or thought pattern that a person is trying to overcome. For example, a person with insomnia may be instructed to stay up as long as possible, instead of trying to force himself or herself to fall asleep. The goal is to reduce the pressure and anxiety associated with the problematic behaviour or thought, which can make it easier to overcome. Dereflection involves shifting a person's attention away from problems in the areas where excessive reflection is a distraction. For example, a person who is excessively self-conscious and disappointed by their sexual performance can be encouraged to dereflect. The one who overthinks his sexual activity kills its spontaneity and disturbs its natural flow of giving himself to another person. Socratic dialogue is a dialogue with a patient helping to identify and challenge underlying assumptions and beliefs. Now it is widely used by other schools of therapies, e.g., cognitive behavioural therapy.
Nowadays, there are two schools of Logotherapy. Alfred Längle, who was a disciple and later even a close friend of Viktor Frankl, separated from Frankl's teaching because of some disagreements on the ideas in logotherapy. He represents the Austrian school of logotherapy. Alfred Längle has developed a framework known as existential analysis, where human behaviour is determined not solely by the will to meaning, which is held as one of the four fundamental motivations. In this approach, logotherapy is an integral part of a wider therapeutic system. The German school, represented by another Frankl's disciple Elisabeth Lucas et al., keeps the approach to logotherapy as seen by Viktor Frankl himself – more as a supplement compatible with any other type of psychotherapy.
Logotherapy seems to be very relevant today, and in my view, it will remain it tomorrow. Even after the war ends, huge gaps and exclusions will still be left in Europe. The hostility and hate between ethnic groups of Russians loyal to their government's position and Ukrainians as well as other nations in Europe do not seem to resolve easily. We need to be cautious about their possible consequences for mental health. Logotherapy might provide a great help here. And despite the quite comfortable life some of us still live, lots of people feel numb and depressed even without experiencing trauma. This state is called existential vacuum by Viktor Frankl and it can be adequately targeted with logotherapy as well.
I should say I am becoming increasingly braver facing challenges while gradually developing logotherapy skills, and, in the first place, experiencing it as a therapy myself.
Surely, logotherapy should not be seen as a replacement for other psychiatric treatments, such as medication or other types of psychotherapy. Rather, it can be applied in conjunction with these treatments to provide a more comprehensive, holistic and long-standing approach to mental health care. □